Measuring cognitive outcomes of stroke patients in the inpatient rehabilitation unit
The Cognitive FIM™ (Cog FIM™) and the Applied Cognitive domain of the Boston University Activity Measure for Post Acute Care (AC AM-PAC) were analyzed in three studies. The responsiveness to change during inpatient rehabilitation of stroke patients was studied for both the Cog FIM™ and the AC AM-PAC. The Cog FIM™ and the AC AM-PAC were then compared with the Reintegration to Normal Living Scale (RNL). The final study concerned the experience of utilizing outcome measures.
The first study sample included 30 FIM™ scores from admission and discharge during inpatient rehabilitation. The hypotheses were: there will be significant change in the Cog FIM™, and there is a relationship between change in the Motor FIM™ and the Cog FIM™. The first hypothesis used the t test and the second, the Pearson correlation coefficient. The 50 stroke patients enrolled in the second study were assessed using the AC AM-PAC at admission and discharge from inpatient rehabilitation and with the Reintegration to Normal Living Scale (RNL) at three months. The hypotheses were: there will be a significant change in the AC AM-PAC, and the AC AM-PAC will predict the RNL more than the Cog FIM™. The first hypothesis used the t-test and the second used hierarchical multiple regression. The third study involved a focus group of clinicians discussing outcome measures.
The Cog FIM™ demonstrated significant change with a moderate effect. There was no relationship between the change of the motor FIM™ and the Cog FIM™. The Change in the AC AM-PAC was not significant but had a moderate effect size. The AC AM-PAC was a better predictor of the RNL than the Cog FIM™, although neither reached significance. The failure to reach significance was likely caused by small sample size. In the third study, the focus group findings revealed concerns about reliability and validity of both measures. This information may lead to future research. In conclusion, the innovations of the AM-PAC have allowed this instrument to overcome some of the limitations of the FIM™.