The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 45
articles solely reflecting on nursing issues were excluded, if no reference is made to
functionality, levels of dependency, as a measuring issue.
Additional documents, especially on the Belgian situation, were retrieved through web-site
search, and contacts with individual experts dealing with minimum nursing data.
4.2.2 Minimum nursing data and rehabilitation: the literature
It has been argued that outcome measures are an important tool in quality assurance
procedures, also in the accountability process of justifying expenses and resources. But it
has been demonstrated too, that there is a great heterogeneity of outcome measures over
Europe 90 . Numerous available measures try to assess aspects of functioning, but they vary
greatly in underlying dimensions and constructs 18 .
A systematic review of measures used in rehabilitation 118 compared available measures to
the ICF. The review finds that the FIM, Barthel Index and Glasgow coma scale are the
most cited assessment instruments. All other formal assessment instruments, were applied
in less than 10% of the studies selected. A recent exercise validated the ICF core sets for
early post-acute rehabilitation facilities, comparing it with FIM, Functional Assessment
Measures (FAM) and Barthel Index (BI), 117 . (See also Appendix for comparison of ICF
core sets, FIM and BI). The authors conclude that FIM and Barthel code abilities to the
level of independence and need of assistance, without explicit reference to the
environment. Many aspects of human functioning are not measured by FIM, FAM and BI.
The authors recommend that, especially for acute neurological conditions, additional items
(besides the ones coded in FIM and BI), need to be coded if the scores are to be used for
prospective payment aims.
Only few articles have focused on a comparison of nursing datasets and rehabilitation
outcome scales, mainly from an American background. The American Minimum Data Set
(Version 2.0) is an American, federally mandated nursing assessment conducted on every
resident of a skilled nursing facility. Authors have argued that it could be used as a simple
tool to collect data and measure outcomes for individuals who receive rehabilitation in the
skilled nursing facility.
In 1998 a “crosswalk” was developed between the FIM, measured in acute rehabilitation
settings and the American minimum dataset (MDS) developed for nursing homes. 119 . A
pseudo-FIM was developed rescaling MDS-items to correspond to FIM-items. Pseudoitems
could be defined for 12 of the 18 FIM items (8 motor and 4 cognitive items). Based
on the testing of the instruments it was argued that FIM and MDS items can be used to
predict item and subscale scores between the two instruments with reasonable accuracy.
It could thus be used to compare case-mix between acute rehabilitation and nursing home
rehabilitation on the level of effectiveness (degree of improvement among similar patients)
and efficiency (cost of care to obtain a given degree of improvement) of rehabilitation care
in different types of settings.
Morris et al. 120 assessed the validity of standardized assessment data collected with the
Minimum Data Set (MDS) in post-acute care settings. This assessment was done for the
development of performance indicators. Performance indicators derived from information
collected with the MDS demonstrate convergent validity with data collected with other
research or standardized assessment instruments. Results were most favorable for areas
of physical functioning, cognitive and communicative functioning, and clinical complexity.
Bryant et al 121 compared the medical outcomes short form SF 36, the MDS for Nursing
Home Resident Assessment and Care Screening which is a major component of the RAI
(Resident Assessment Instrument for long-term care), FIM and IRF-PAI (Inpatient
Rehabilitation Facility-Patient Assessment Instrument). They observed that all evaluated
datasets include items that assess ADL, ambulation and locomotion, and
neuro/emotional/behavioral status (primarily cognition and depression). All except the SF-
36 contain items concerning sensory status (eg, vision, hearing, speech), (in)continence,
and some measure of physical ability. But the instruments do not specify the data items
identically or have identical response options. Items differ in perspective; qualification;
source (patient and/or caregiver); and action versus outcome or tool (eg, walking vs
wheelchair). Time periods covered also vary considerably. Based on this observational