Using Rasch Motor FIM™ Individual Growth Curves to Inform Clinical Decisions for Persons with Paraplegia

Spinal Cord, 2014 · DOI: 10.1038/sc.2014.94 · Published: September 1, 2014

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

This study uses data from the National Spinal Cord Injury Database (NSCID) to understand how functional independence changes over time for individuals with paraplegia. The researchers used individual growth curve (IGC) analysis to create an interactive tool that shows detailed individual-level changes as measured by the motor subscale of the FIM™ instrument. Clinicians can use this tool to make better decisions about interventions and goal setting for patients, based on projected admission scores, plateaus, and the time expected to reach those plateaus.

Study Duration

Not specified

Participants

4504 participants with paraplegia in the NSCID

Evidence Level

Level 3, Retrospective longitudinal database study

Key Findings

1
The study generated non-linear individual level trajectories of recovery for Rasch Transformed Motor FIM™ scores that rise rapidly from inpatient rehabilitation admission to a plateau.
2
Covariates such as race, gender, education level, age at injury, neurological level, AIS grade, time from injury to admission, rehabilitation length of stay, marital status, and etiology are related to the growth parameters.
3
An interactive tool was developed to represent individual level longitudinal outcomes as trajectories based upon an individual’s given baseline characteristics.

Research Summary

This study used individual growth curve (IGC) analysis on data from the National Spinal Cord Injury Database (NSCID) to understand functional independence changes over time for individuals with paraplegia. The primary goal was to construct an interactive tool providing a detailed description of individual level change as measured by the motor subscale of the FIM™ Instrument. The interactive tool allows clinicians and researchers to generate patient-specific trajectories, facilitating better planning for inpatient and outpatient services and potentially impacting long-term outcomes.

Practical Implications

Clinical Decision-Making

Clinicians can use the interactive tool to base intervention planning and goal setting on a temporal projection of individual level information, considering admission score, plateau, and time to plateau.

Research Planning

The tool can inform research planning by defining study inclusion and exclusion criteria based on the time to reach stability, potentially improving the definition of chronic SCI.

Enhanced Goal Setting

By converting 11-RTFMS scores into raw motor FIM™ scores and using Rasch KeyForms, clinicians can make item-level comparisons and adjust intervention strategies to better address individual variations in motor functioning.

Study Limitations

1
Trajectories are estimates based on participants meeting specific inclusion/exclusion criteria and may not fully represent recently injured participants.
2
Trajectories are descriptive, and comparisons should be based on clinical relevance alone, not solely on mathematical projections.
3
Many factors, such as concomitant medical conditions, family support, and motivation, are not included in the modeling process.

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