Résumé :
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An assessment of functional capacity is essential before starting any rehabilitation treatment and is a prerequisite if compensatory strategies and technical aids are to be suggested to patients. The Functional Independence Measure (FIM™) was published in 1987 by Hamilton and Granger. In the United States it is the benchmark instrument in physical and rehabilitation medicine (PRM), and is used in research, clinical practice and in the assessment of patient care quality. The paediatric version is known as the Wee-FIM. As a benchmark tool in PRM, it enables dependence to be assessed in terms of motor, cognitive, psychological and behavioural capacity, by measuring limitations and the need for assistance. It is an 18-item ordinal scale, including communication and social cognition. Overall, there are 13 items for "motor" assessment and 5 for "cognitive" assessment. Numerous studies have clarified the weighting between self care items, mobility and cognition. This is useful for assessing severity which is measured on a 7 point scale (1 = total assist/complete dependence; 7 = complete independence). The score is set between 18 and 126 but the grid enables you to calculate sub-scores with relation to self care, sphincter control, mobility, locomotion, communication and social cognition. This enables you to create a star-shaped graphic representation of the patient's "FIM profile". Scoring is based on direct observation or on the carer's account of the patient. Scoring takes 15 to 30 minutes for trained personnel. A manual suggests specific questions to elicit the responses that best match the subject's condition. The FIM is a good communication tool for the rehabilitation team enabling them to assess the patient's capacity to perform basic actions alone or with help. It can be used at the beginning of treatment or as it progresses. The diagram takes account of the "amount" of independence the patient currently has and/or that the patient aims to regain. It can be used with hospitalised patients or with out-patients. However, the FIM is subject to copyright. International authorisation of its applications and the acceptance of publications referring to it are also subject to this. Although the FIM is widely used due to its wide publication and its uncontested value, it still remains "confidential" and studies using it cannot constitute international references. A study that is in progress (IFR-25) should make it easier to use it in future. Due to the degenerative nature of their diseases, neuromuscular patients gradually lose some of their functional capacities. It is important to be able to quantify this clinical deterioration at each assessment in order to be able to offer them material and/or human resources. A generic, user-friendly and widely recognised assessment tool like the FIM could contribute to making patient requirements clear and objective. Bibliography Charmet E, Bethoux F, Calmels P, Gautheron V, Minaire P: 'Wee FIM: study of reproducibility and investigation of a population of healthy children aged 1 to 9 years (sample of 167 subjects)'. Annales de Médecine Physique et de Réadaptation 1996; 39:15-9. Calmels P, Bethoux F: Relationship between quality of life and rehabilitation in neuromuscular diseases. Ann Phys Med Rehabil 2001; 44(Suppl 1):274-80. Bethoux F, Calmels P: Guide des outils de mesure et d'évaluation en Médecine Physique et de Réadaptation; Frison-Roche ed. Paris 2003:403 p.
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