How do we Measure Success of Rehabilitation
How do we Measure Success of Rehabilitation
When we talk about treatment success, recovery or patient outcomes, what criteria can we use to measure this? Certainly patient feedback is key, as is the ability to achieve things they couldn’t do before.
But what objective measures do we use to determine if rehabilitation is working?
We work towards internationally approved standards which show how successful our rehabilitation has been. These results of treatment, or ‘outcome measures’ as they’re called, have a benchmark which we use as a comparison. We can then use this data to customise a treatment plan for a patient, and ultimately use the data to determine when they’re ready to go home.
To achieve this, we use a global measure of disability called ‘FIM+FAM’. Here’s a bit more about FIM+FAM and what it all means…
41% improvement in personal grooming
Circle Rehabilitation ensures a holistic view is taken when planning a patient’s therapy and specific emphasis is placed on personal care. Our results demonstrate that patients have a significantly greater ability to wash their face, clean their teeth, brush their hair, and shave.
93% improvement in showering and washing
As a result of intensive and targeted rehabilitation, patients report a greater ability to wash and shower. The unit has specialist equipment that enables patients to maintain and improve these fundamental parts of everyday life.
In one case, a previous patient managed to have an assisted shower within 4 days of being a patient at Circle Rehabilitation. This was despite being a patient at other facilities for over 8 months previously.
123% improvement in toileting
Going to the toilet is a commonly reported problem following a stroke or if suffering with a neurological disease. This is due to damage to the central nervous system that controls this essential bodily function. However, as a result of nurse-led bladder and bowel training programmes, our patients report a significant improvement in their bladder and bowel function which means they can better control when they need to go to the toilet.
133% improvement in toilet transfer
Being able to control your bladder and bowel is one thing, however you need to be able to safely transfer on or off the toilet or commode in a timely fashion. Intensive rehabilitation with our occupational and rehabilitation assistants help our patients to significantly improve getting on or off the toilet.
154% improvement in walking
Being able to walk again is one of the most commonly reported goals patients strive for at the start of their care, often being the focus of physiotherapy. Our highly skilled therapists will use a combination of assisted walking devices and specific techniques to help patients to improve their mobility, and this has been demonstrated with an average improvement of 154% in our patients’ ability to walk following diagnosis of a neurological injury or disease.
30% overall functional improvement
The FIM+FAM outcome measure can also provide an overall functional improvement, which takes into consideration all 30 items of the scoring system and includes both motor (movement) and cognitive aspects of a patients function. Our results indicate that on average a patient will improve by 30% following their stay on our rehabilitation unit.
FIM+FAM is short for ‘Functional Independence Measure and Functional Assessment Measure’. It’s formed by two assessments, with each able to be used independently or combined into a larger ‘FIM+FAM’ measure. These assessments are internationally approved outcome measures used to accurately measure disability in the UK. The assessments have a set list of criteria which are used regularly before, during and after treatment. That way we can accurately see changes in how a patient is responding to rehabilitation in real-time and adjust the treatment plan if needed.
The FIM+FAM score measures disability due to brain injuries and consists of 30 functional items to be scored between 1 (total assistance) and 7 (complete independence) amounting up to a total possible score of 210. A score of 7 indicates ‘complete independence’ with no assistance needed to complete the task in a safe and timely manner. A score of 1 represents ‘total assistance’ where a significant amount of support is needed to achieve the activity.
FIM, the first part of the measure, is an 18-item assessment looking at what we call ‘independence of daily living’. The team looks at everyday scenarios to give an overall score from 1-7 at that particular time for an activity.
Here’s some examples from the FIM assessment:
- Dressing upper body
- Dressing lower body
So what about the FAM measure? This can be used as a standalone measure, or it can used alongside the FIM assessment above. Examples of the FAM assessment include:
- Emotional status
- Social interaction
- Safety awareness
Independent – Another person is not required for the activity (no helper)
7 – Complete independence
The person performs all of the tasks described as making up the activity within a reasonable amount of time, and does so safely without the need for modification, assistive decisions or aids. (No help, no devices, safe and timely)
6 – Modified independence
One or more of the following may be true:
a) uses an assistive device
b) takes longer than the reasonable amount of time
c) there is some concern for safety
(No help, but uses a device, or issues for safety or timeliness)
Dependent – Receives help from another person to perform the activity, or the activity is not performed (requires helper)
- Modified dependence: The person performs more than half of the tasks themselves
5 – Supervision or set-up
Receives no more than stand-by cueing, coaxing or verbal prompting without physical contact OR help just to set-up equipment, apply orthosis, etc. (No help, but set-up or verbal prompting)
4 – Minimal assistance
No more help than touching
Receives incidental help ONLY to complete the task – does >75% themselves. (help at the level of touching only)
3 – Moderate assistance
More help than touching
Receives moderate help, but still performs 50-75% of the task themselves. (Hands on help but patient does more than half the task themselves)
Complete dependence – The person performs less than half the task
2 – Maximal assistance
Receives substantial assistance – the person provides 25-49% of the effort to complete the task. (Patient does less than half the task themselves, but does contribute)
1 – Total assistance
Receives total assistance – the person contributes less than 25% of the effort or the activity is not performed. (Patient unable or does very litter (<25%) of the task.
It is very important to track a patient’s progress using validated and standardised outcome scores. It helps to guide the treatment and also plan for when the patient can return home. It can also be used as a very effective motivator, as patients can clearly see how much they have changed. This is especially relevant for patients who have rehabilitation over prolonged periods, when the change from admission to discharge can be quite dramatic, especially when day-to-day changes are less apparent.