Page 112 - Handbook of Electronic Assistive Technology

Chapter 4 • Assessment and Outcomes 99

Functional Independence Measure 11

This is an 18-item, seven-level scale that assesses physical, psychological and social
function. The tool is used to assess a patient’s level of disability, as well as change in
patient status in response to rehabilitation or medical intervention. Level 1 is total
independence and level 7 is complete dependence. Physical items to be scored are
eating, grooming, bathing, dressing upper body, dressing lower body, bladder, bowls,
toileting, transfer (bed, chair and wheelchair), toilet transfer, tub/shower and walk or
wheelchair. The cognitive items to be scored are comprehension, expression, problem
solving, social interaction and memory. This measure has been widely used in a range
of rehabilitation areas, including determining the efficacy of upper-limb robotics (Daly
et al., 2005).
Goal Attainment Scaling 12

This is a technique for quantifying the achievement (or otherwise) of goals set, which are
used in rehabilitation. Specific goals are set up between the clinician, the service user and
their carers or network of support. This is done by agreeing on priorities and their achieve-
ment by an agreed date. They are then scored using a five-point scale of attainment with
two points above and two points below the original goal. Normally, three or four goals
are identified and if the user achieves the expected level they are scored at 0. If the user
achieves better than expected the score is +1, somewhat better, or +2, much better. Where
the user achieves less than the expected outcome this is scored at −1, somewhat worse, or
−2, much worse (Turner-Stokes, 2009).
It is evident that most outcome measures serve a specific purpose capturing data in
areas such as general clinical effectiveness, aspects related to the provision of AT or quality
of life.
AT outcomes could well encompass a composition of various elements such as facilita-
tion of activities of daily living, change in functional independence, effects on participa-
tion, functional independence, participation satisfaction and societal and individual gain
(Jutai et al., 2005).
Variability among AT users and their goals, limited availability and clinical utility of
tools contribute to the challenges of capturing outcome measures (De Jonge et al., 2007).
Research is limited in this area and where papers have been published they are on a small
scale with small participant numbers (Fuhrer et al., 2003; Lenker et al., 2005; Edyburn,
2015). It is, however, recognised that outcome measures are critical in decision making
and ensuring quality assurance in service delivery (Douglas et al., 2005; Layton, 2012).
Desideri et al. (2015) propose adopting a structured and user centre approach to docu-
menting AT outcomes in everyday practice.

11 https://www.physio-pedia.com/Functional_Independence_Measure_(FIM).
12 https://www.kcl.ac.uk/nursing/departments/cicelysaunders/attachments/Tools-GAS-Practical-Guide.pdf.