The Study Of The Functional Comprehensive Assessment(FCA) For Stroke Patients' Comprehensive Function

A national Uniform Data System for Medical Rehabilitation(UDSMR) was established in USA in 1983.The system collects data of discharge and follow-up patients to evaluate functional status in main rehabilitation hospitals in the US.The Functional Independence Measure(FIM) has been widely used up to now to evaluate patient's function in UDSMR.FIM has been verified a good reliable and forecasting index of patient's rehabilitation outcome.However,if FIM is used in China,we would not only offend the copyright and pay expensive training and using fees but also some items of FIM Scale do not fit Chinese situation.Miao Hongshi et al.has designed a Comprehensive Functional Evaluation(CFE) after having sufficiently considered Chinese situation.However,CFE isn't tested and verified,and the method of calculation of it is complicated.To improve the rehabilitation treatment of stroke in China,it is necessary to design a scale for comprehensive function assessment.The Functional Comprehensive Assessment(FCA) was designed after we had consulted CFE,FCA and rehabilitation medicine experts in 20 medical university affiliated hospitals and province hospitals.The study is to examine the reliability,validity, sensitivity and practicability of FCA for stroke patients' comprehensive function.We hope to provid a scientific and advanced scale in China.Part one:The study of the reliability,validity and sensitivity of the functional comprehensive assessment(FCA)Abstract one:A initial research on reliability of functional comprehensive assessmentObjective:To investigate the reliability of the functional comprehensive assessment(FCA) among stroke patients.Method:Twenty stroke patients were measured using the FCA.For reliability,intrarater and interrater agreement were analyzed.Internal consistency of the FCA was calculated using Cronbachα.Result: FCA has a good intrarater and interrater reliability.Every item's ICC is between 0.79 and 0.99(ICC total＞0.900).And also FCA has a goodoverall internal consistency(motor subscoreα=0.93,cognitive subscoreα=0.98,FCA total score α=0.96).Conclusion:FCA has a good retest reliability and good internal consistency. It is a good comprehensive functional measurement for stroke patients.Abstract two:A initial research on validity of functional comprehensive assessmentObjective:To investigate the validity of the functional comprehensive assessment(FCA) among rehabilitation in-patients.Method:20 patients(stroke:7 cases;traumatic brain injury:6 cases;patient who submitted brain tumor removing: 5 cases;spinal cord injury:2 cases)were measured.Interrelationships between Barthel index(BI) and FCA motor subscale,between minimental state examination(MMSE)and FCA cognitive subscale,between the quality of life index(QLI) and FCA social communication subscale were investigated.Result:FCA motor scores was significantly correlated to BI(r=0.977 P＜0.001).FCA cognitive scores was significantly correlated to MMSE(r=0.926 P＜0.001).FCA social contact scores was also significantly correlated to QLI(r=0.978 P＜0.001).Conclusion:FCA has good validity in functional evaluation among in-patients with common disabilities.Abstract three:Assessment of the reliability,validity and sensitivity of the functional comprehensive assessment(FCA) for stroke patientsObjective To examine the reliability,validity and sensitivity of FCA for patients with stroke.Methods A total of 82 patients with stroke were divided into a treatment group and a control group randomly.The patients in the control group were given routine internal medicine treatment,while those in the treatment group were given standardized rehabilitation therapy in addition to the routine internal medicine treatment.All patients were assessed with FCA and Modified Barthel Index(MBI),at admission and the end of 1st month,3rd and 6th month respectively after the onset of stroke.The internal consistency,split-half reliability,content validity,criteria validity and sensitivity of FCA were tested.Repeat measure ANOVA and correlation analysis were used in the statistical analysis.Results There existed a good internal consistency(Cronbachα=0.901～0.973) as well as a good split-half reliability (R=0.949～0.981) of FCA.There was a medium to strong correlation among the 18 items scores of the FCA and FCA scores(P＜0.01).FCA BADL subscale was significantly correlated to MBI(r=0.41～0.98,P＜0.01).FCA scores,FCA motor scores and FCA cognitive scores were significantly improved after rehabilitation therapy in the treated group(P＜0.01).The effect size of FCA is good.Conclusion FCA was a sensitive instrument for assessing the comprehensive function of patients with stroke and has very good reliability and validity.Part two:The study of the practicability of the aunctional comprehensive assessment(FCA)Abstract one:The relationship between the initial stage FCA score and costs and hospital day in stroke patients received standard tertiary rehabilitation Objective To investigate the characteristics of the costs in stroke patients received standard tertiary rehabilitation,the relationship of the initial stage functional comprehensive assessment(FCA) scores with the costs of major items and length of stay(LOS).Method Eighty two patients of primary cerebral infarction and primary cerebral hemorrhage were divided into treated group and controlled group randomly. Patients in the treated group were given standardized tertiary rehabilitation,while those in the controlled group received normal internal medicine treatments but without standardized tertiary rehabilitation.All patients were assessed with the scale of FCA at admission after stroke.Every patient's direct medical costs,direct non-medical costs,indirect costs,and detailed buildups of every cost during the stage of 6 months' rehabilitation were collected.T-test and correlation analysis was used in statistics.Result The differences of LOS and total costs hadn't the statistical significant between the two groups(P＞0.05).The FCA scores at the admission were negatively correlated to LOS,direct medical costs and total costs in two groups patients(r=-0.331～-0.489,P＜0.01～0.05).The FCA motor subscale scores at admission were negatively correlated to direct medical costs,total costs and LOS in the treated group(r=-0.145～-0.463,P＜0.01～0.05).The FCA cognition subscale scores at admission negatively correlated to direct medical costs,total costs and LOS in the controlled group(r=-0.331～-0.542,P＜0.01～0.05).LOS was significantly positive correlated to direct medical costs,direct non-medial costs and total costs in two groups patients(r=0.301～0.887,P＜0.01).Conclusion There is marked positive relationship between LOS and direct medical costs,direct non-medial costs,total costs in stroke patients.Direct medical costs and total costs are related to the severity of comprehensive function at the initial stage of stroke.The initial stage FCA score may be able to predict the direct medical costs,total costs and LOS in stroke patients. The initial stage FCA motor subscale score may be able to predict the direct medical costs,total costs and LOS in stroke patients who received standardized tertiary rehabilitation.The initial stage FCA cognition subscale score may be able to predict the direct medical costs,total costs and LOS in stroke patients without standardized tertiary rehabilitation.Abstract two:Analysis of multiple factors correlated with the six months prognosis of comprehensive function in patients with strokeObjective To investigate the multiple early variables that influenced the 6th months prognosis of comprehensive function in patients with stroke.Methods Two hundreds and eleven patients of primary cerebral infarction and primary cerebral hemorrhage in Shanghai were divided into treated group and controlled group randomly.Patients in the treated group were given standardized tertiary rehabilitation,while those in the controlled group received normal internal medicine treatments but without standardized tertiary rehabilitation.Twenty seven early variables were collected with regard to the patients' medical history,physical examination,scores with CNFD, S-FMA and MBI at the time of enrollment.The patients' FCA scores at the ends of the 6th months after stroke were used as the comprehensive functional outcome. Stepwise multiple regression analysis applied to analyze the data.Results Stepwise multiple regression analysis revealed that therapeutic regimen,CNFD scores,age, diabetes mellitus,S-FMA scores,smoking and labour intensity predicted comprehensive functional outcome at the ends of the 6th months after stroke. Conclusion Certain early variables predict the long-term comprehensive functional prognosis of stroke patients.Therapeutic regimen,CNFD scores and age were significant predictors.