Original article
Agreement Between Patient and Proxy Responses During Recovery After Hip Fracture: Evidence for the FIM Instrument

https://doi.org/10.1016/j.apmr.2006.06.008Get rights and content

Abstract

Jones CA, Feeny DH. Agreement between patient and proxy responses during recovery after hip fracture: evidence for the FIM instrument.

Objective

To evaluate the agreement between patient and proxy responses of the FIM instrument at 4 different periods of time during the first 6 months after hip fracture.

Setting

A large urban health region with 2 tertiary hospitals that treat hip fractures.

Participants

Patients (n=137) who were 65 years or older, admitted to the health region with a primary diagnosis of hip fracture, who had Mini-Mental State Examination scores greater than 17. Family caregivers (n=137) participated as proxy respondents.

Interventions

Not applicable.

Main Outcome Measure

The FIM instrument. Agreement was evaluated at each of the 4 assessments during the 6-month follow-up after hip fracture using intraclass correlation coefficient.

Results

FIM scores improved over the 6 months with the greatest improvement occurring within the first month of recovery. Agreement was higher for more observable activities than less observable ones. The magnitude of agreement improved over the 6 months with the proportion of clinically important systematic differences decreasing over time. Agreement for change scores was lower than the agreement at each of the 4 assessments.

Conclusions

Patient-proxy agreement levels are acceptable; the agreement varies with the subscale and the recovery phase. Substitution of proxy for patient responses across time may be used guardedly when patient responses are missing.

Section snippets

Participants

We based the current study on data obtained from participants who were part of a larger prospective cohort study examining recovery after hip fracture in a community-based patient population. Patients were eligible for this study if they resided within the large urban health region (Capital Health, Edmonton, AB, Canada), where all hip fracture patients were surgically treated in 1 of 2 tertiary hospitals from October 2000 until December 2001. Within this public health care system, all patients

Results

The baseline characteristics of the patient and proxy pairs are summarized in table 1. The median number of days between patient and proxy responses for baseline was 1.0 day (interquartile range [IQR], 1–2); for the follow-up interviews, the patient and proxy interviews occurred on the same day (median, 0d; IQR, 0–2). The FIM scores for each assessment are displayed in table 2. Mean baseline score ± standard deviation for patients was 70.3±13.8 and improved over the 6 months to 105.3±16.8,

Discussion

The level of agreement between patients with hip fractures and proxy caregivers is reasonable when using the FIM instrument. Agreement, however, varied by subscale and the assessment period. Overall, the level of agreement was higher for observable dimensions such as locomotion and mobility than for bowel and bladder which is generally not as observable. Others have also reported similar findings with the FIM in different patient cohorts.31 We found that the levels of agreement were similar for

Conclusions

Agreement was high for the FIM instrument over the 4 assessments. While patient and proxy responses had higher levels of agreement when patients were more likely to be medically stable, agreement was nonetheless reasonable during the more acute phases of recovery. This result implies that proxy responses can be used at specific points in time, and also can be used to measure change over time. Patient-proxy agreement levels are acceptable; the agreement varies with the subscale and the recovery

Acknowledgments

The funding agencies played no role in the design, interpretation, or analysis of the project reported here and have not reviewed or approved this manuscript.

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    Supported by the Institute of Health Economics, University of Alberta Hospital Foundation, Royal Alexandra Hospital Foundation, Edmonton Orthopaedic Research Trust, and Alberta Heritage Foundation for Medical Research.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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    Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.