Comparative assessment of Barthel index and functional independence measure in providing rehabilitation care for military personnel with combined injuries

Kostyantyn Babov; Alexander Plakida; Iryna Balashova; Iryna Zabolotna; Sergey Gushcha; Dmytro Bobylov

doi:10.15391/prrht.2025-10(1).07

Authors

Kostyantyn Babov State Institution «Ukrainian Research Institute of Medical Rehabilitation and Resort Therapy of the Ministry of Health of Ukraine», Odessa, Ukraine https://orcid.org/0000-0003-2066-6152
Alexander Plakida State Institution «Ukrainian Research Institute of Medical Rehabilitation and Resort Therapy of the Ministry of Health of Ukraine» https://orcid.org/0000-0002-7537-7596
Iryna Balashova State Institution «Ukrainian Research Institute of Medical Rehabilitation and Resort Therapy of the Ministry of Health of Ukraine», Odessa, Ukraine https://orcid.org/0000-0002-7529-4045
Iryna Zabolotna State Institution «Ukrainian Research Institute of Medical Rehabilitation and Resort Therapy of the Ministry of Health of Ukraine», Odessa, Ukraine https://orcid.org/0000-0002-0159-2058
Sergey Gushcha State Institution «Ukrainian Research Institute of Medical Rehabilitation and Resort Therapy of the Ministry of Health of Ukraine», Odessa, Ukraine https://orcid.org/0000-0003-3097-5258
Dmytro Bobylov Kharkiv State Academy of Physical Culture, Kharkiv, Ukraine https://orcid.org/0009-0005-3298-9073

DOI:

https://doi.org/10.15391/prrht.2025-10(1).07

Keywords:

Rehabilitation, combined wounds, Barthel Index, Functional Independence Measure

Abstract

In the structure of military traumatism, the number of multiple and combined wounds and injuries has increased significantly due to the expansion in the destructive properties of modern weapons. Establishing the correct rehabilitation diagnosis and subsequent stage-by-stage assessment of the results of rehabilitation therapy should be based on adequate functional assessment tools. The Barthel Index is the most widely used measure for assessing the ability to perform activities of daily living. However, recently, many authors have proposed using the Functional Independence Measure (FIM) for this purpose.

Purpose. The study aims to investigate the possibility of using the Barthel Index and Functional Independence Measure to assess the effectiveness of rehabilitation of military personnel with combined injuries over a long period.

Material & Methods. We conducted a retrospective study of 807 wounded military personnel with complex injuries of varying severity. Our examination included a meticulous analysis of medical records, a comprehensive physical examination, and a survey using the Barthel Index and FIM scale. Due to the nature of the injuries, the servicemen were provided with standard rehabilitation programs.

Results. All patients were classified as lightly injured and moderately injured according to the Abbreviated Injury Scale. The initial data in evaluating functioning on the FIM scale made it possible to identify subgroups of patients with a predominance of motor function impairment and a predominant impairment of cognitive functions. Patients with combined TBI should receive more rehabilitation measures to improve cognitive and mental functions, socialization, and communication skills.

Conclusions. The inclusion of the FIM scale in the recommended toolkit for assessing the effectiveness of rehabilitation will allow for additional objectification of rehabilitation care and the formulation of individual recommendations for achieving the best results.

References

Alookaran, S., Cannon, E., Williams, D., O’Donnell, M., Harty, E., Shovlin, L., et al. (2022). 120 comparing the functional independence measure and the barthel index for assessment of older adults. Age And Ageing, 51(Supp 3). https://doi.org/10.1093/ageing/afac218.099

Ann Peleg, D, & Justo, D. (2024). Functional independence measure scale scores in severely depensent olser adults upon rehabilitation completion following stroke. Harefuah,163(6), 359-364. PMID: 38884288.

Barros, V., Bassi-Dibai, D., Guedes, C., Morais, D., Coutinho, S., Simoes, G., et al. (2022). Barthel Index is a valid and reliable tool to measure the functional independence of cancer patients in palliative care. BMC PALLIATIVE CARE, 21(1). https://doi.org/10.1186/s12904-022-01017-z

Belrose, C, Duffaud, AM, Dutheil F, Trichereau, J, Trousselard, M. (2019). Challenges associated with the civilian reintegration of soldiers with chronic PTSD: a new approach integrating psychological resources and values in action reappropriation. Front Psychiatry, 9, 737. https://doi.org/10.3389/fpsyt.2018.00737

Caronni, A., & Scarano, S. (2024). Generalisability of the Barthel Index and the Functional Independence Measure: robustness of disability measures to Differential Item Functioning. Disability And Rehabilitation. https://doi.org/10.1080/09638288.2024.2391554

Çerezci, Ö, & Boneval, F. (2023). The assessment of stroke patients using the Functional Independence Measurement Scale. J Eur Int Med Prof,1(3),72-81. https://doi.org/10.5281/zenodo.8135432

Chernozub A., Tsos A., Olkhovyi O., Ikkert O., Koval V., Kirychuk Y. (2024) Comparative study of adaptive reserves of servicemen and servicemen-athletes with neuromuscular injuries after the post-acute rehabilitation. Physical rehabilitation and recreational health technologies. 9(6):468-475. https://doi.org/10.15391/prrht.2024-9(6).02

Chokshi, K., Tedla, J., Narayan, A., Ganesan, S., & Reddy, R. (2021). Functional independence measure (WeeFIM) reference values in Indian children aged 3-7 years: A cross-sectional study. National Medical Journal of India, 34(2), 73-78. https://doi.org/10.4103/0970-258X.326748

Chumney, D, Nollinger, K, Shesko, K, Skop, K, Spencer, M, Newton, RA. (2010). Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: systematic review. J Rehabil Res Dev,47(1),17-29. https://doi.org/10.1682/jrrd.2009.08.0140

Collin, С, Wade, D, Davies, S, Horne, V. (1988). The Barthel ADL Index: a reliability study affiliations expand. Int Disabil Stud, 10(2), 61-3. https://doi.org/10.3109/09638288809164103

Colomer, C., Llorens, R., Sánchez, C., Ugart, P., Moliner, B., Navarro, M., et al. (2023). Reliability and validity of the Spanish adaptation of the Functional Independence Measure plus Functional Assessment Measure. European Journal of Physical And Rehabilitation Medicine, 59(4), 452-457. https://doi.org/10.23736/S1973-9087.23.07841-3

Dos,Reis, N., Figueiredo, F., Biscaro, R., Lunardelli, E., & Maurici, R. (2022). Psychometric properties of the Barthel index used at intensive care unit discharge. American Journal of Critical Care, 31(1), 65-72. https://doi.org/10.4037/ajcc2022732

Gao, Y., Wang, Y., Li, D., Zhao, J., Dong, Z., Zhou, J, et al. (2021). Disability assessment in stroke: Relationship among the pictorial-based Longshi Scale, the Barthel Index, and the modified Rankin Scale. Clinical Rehabilitation, 35(4), 606-613. https://doi.org/10.1177/0269215520975922

García-Rudolph, A., Wright, M., García, L., Sauri, J., Cegarra, B., Tormos, J., & Opisso, E. (2024). Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation. Journal of Spinal Cord Medicine, 47(5), 649-660. https://doi.org/10.1080/10790268.2023.2183326

Granger, CV, Hamilton, BB, Linacre, JM, Heinemann, AW, Wright, BD. (1993). Performance profiles of the functional independence measure. Am J Phys Med Rehabil,72(2), 84-9. https://doi.org/10.1097/00002060-199304000-00005

Güp, A., Dongaz, Ö., Oruk, D., Deveci, E., Bayar, B., & Bayar, K. (2023). Prediction of hospitalization time and independence level with functional outcomes for patients with acute stroke: a retrospective study. Neurological Research, 45(10), 947-956. https://doi.org/10.1080/01616412.2023.2252275

Hachisuka, K, Okazaki, T, Ogata, H.(1997). Self-rating Barthel index compatible with the original Barthel index and the Functional Independence Measure motor score. J UOEH, 19(2), 107-21. https://doi.org/10.7888/juoeh.19.107

Harvey, LA, Glinsky, JV, Chu, J. (2021). Do any physiotherapy interventions increase spinal cord independence measure or functional independence measure scores in people with spinal cord injuries? A systematic review. Spinal Cord, 59(7), 705-715. https://doi.org/10.1038/s41393-021-00638-0

Hoenig, H., Branch, L., McIntyre, L., Hoff, J., & Horner, R. (1999). The validity in persons with spinal cord injury of a self-reported functional measure derived from the functional independence measure. SPINE, 24(6), 539-543.

Izumi, H. (2019). Use of the functional independence measure in Japanese rehabilitation team interaction. Discourse Studies,21(6), 660-689. https://doi.org/10.1177/1461445619866981

Kakehi, S., Takemura, R., & Wakabayashi, H. (2023). Comment on relationship between initial nutritional status and functional independence measures at discharge in sub- acute stroke. Journal of Stroke & Cerebrovascular Diseases, 32(3). https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106954

Katano, S., Yano, T., Ohori, K., Kouzu, H., Nagaoka, R., Honma, S., et al. (2021). Barthel Index score predicts mortality in elderly heart failure: a goal of comprehensive cardiac rehabilitation. European Heart Journal, 42, 2809-2809.

Khomenko, I, Khoroshun, E, Makarov, V, Nehoduiko, V, Tertyshnyi, S, Maidaniuk, V, et al. (2022). Choice of the system for evaluating the severity of combat surgical injuries in the wounded with gunshot defects of soft tissues at medical support levels І-ІІ. Hospital surgery,3, 5-12. Ukrainian. https://doi.org/10.11603/2414-4533.2022.3.13386

Klyce, D., Perrin, P., Ketchum, J., Finn, J., Juengst, S., Gary, K., et al. (2024). Suicide Attempts and Ideation Among Veterans/Service Members and Non-Veterans Over 5 Years Following Traumatic Brain Injury: A Combined NIDILRR and VA TBI Model Systems Study. Journal of Head Trauma Rehabilitation, 39(3), 183-195. https://doi.org/10.1097/HTR.0000000000000902

Lee, C., Chan, G., & Tengah, D. (2022). Functional outcome using the modified Barthel index(mbi) in acute ischemic stroke(ais) post intravenous thrombolysis patients. International Journal of Stroke, 17(3_SUPPL), 228-228.

Lee, E., Sohn, M., Lee, J., Kim, D., Shin, Y., Oh, G., et al. (2022). Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. International Journal of Environmental Research And Public Health, 19(15). https://doi.org/10.3390/ijerph19159612

Lurin, I, Khomenko, I, Gozhenko, O, Nehoduiko, V, Herasimenko, O, Tertyshnyi, S, et al. (2023). Staged rehabilitation of military personnel as part of a multimodal approach to the gunshot soft tissue defects reconstruction. Acta Balneologica, 65(5), 285-291. https://doi.org/10.36740/ABal202305104

Maritz, R., Fellinghauer, C., Brach, M., Curt, A., Gmünder, H., Hopfe, M., et al. Independence measure and spinal cord independence measure for outcome and quality in the rehabilitation of persons with spinal cord injury. Journal Of Rehabilitation Medicine, 54. https://doi.org/10.2340/jrm.v54.82

Mellick, D. (2023). Assessment and evaluation of a crosswalk between the functional independence measure and the continuity assessment record and evaluation. Brain Injury, 37, 74-75. https://doi.org/10.25677/vztj-c530

Olkhovyi O., Klymovych V., Romanchuk S. (2016). Adoption of youth`s bodies to educational conditions in higher educational institutions. Journal of Physical Education and Sport. 16 Supplement issue (1), Art 98. 620-622. https://doi.org/10.7752/ jpes.2016.s1098)

Olkhovyi O., Chernozub A., Danylchenko S., Korchagin М., Romanchuk S., Oderov A., Klymovych V., Zhembrovskyi S. (2020). Experience of determining the priority of complex process or system (on the example of physical education and sport). Journal of Physical Education and Sport, Vol 20 (Supplement issue 6), Art 451. 3330-3335. https://doi.org/10.7752/jpes.2020.s6451

Potcovaru, C-G, Salmen, T, Bîgu, D, Săndulescu, M, Filip, P, Diaconu, L, et al. (2024). Assessing the effectiveness of rehabilitation interventions through the World Health Organization Disability Assessment Schedule 2.0 on Disability—A systematic review. J. Clin. Med,13(5), 1252. https://doi.org/10.3390/jcm13051252

Pozin, M., Najafali, D., Naik, A., MacInnis, B., Subbarao, N., Zuckerman, S., & Arnold, P. (2024). Long-term assessment of the functional independence measure in sports-related spinal cord injury. Journal Of Spinal Cord Medicine, 47(2), 214-228. https://doi.org/10.1080/10790268.2023.2167903

Rapsang, A, Shyam, D. (2015). Scoring Systems of Severity in Patients with Multiple Trauma. Cirugía Española (English Edition), 93(4), 213-221. https://doi.org/10.1016/j.cireng.2013.12.031

Babov, K. (2023). Rehabilitation of military personnel in sanatoriums and health resorts and rehabilitation institutions: a monograph.

Shakargy, J.D., Gendler, S., Talmy, T., Shushan, G., Radomislensky, I., Tsur, A., et al. (2023). Blast Injury Patterns Among Israel Defense Forces Fatalities. Mili Med, 188(7-8), E1788-E94. https://doi.org/10.1093/milmed/usac280

Van Ditshuizen, J., Sewalt, C., Palmer, C., Van Lieshout, E., Verhofstad, M., & Hartog, D. (2021). The definition of major trauma using different revisions of the abbreviated injury scale. Scand J Trauma, Resuscitation and Emergency Medicine, 29,71. https://doi.org/10.1186/s13049-021-00873-7

Wang, Y., Chang, P., Chen, Y., Lee, Y., Huang, S., Chen, M., & Hsieh, C. (2023). Comparison of responsiveness of the Barthel Index and modified Barthel Index in patients with stroke. Disability And Rehabilitation, 45(6), 1097-1102. https://doi.org/10.1080/09638288.2022.2055166

Weinrebe, W, Vonlanthen, KJ, Goetz, S. (2020). FIM-score predictors of discharge destination in older patients admitted for inpatient rehabilitation. Tasman Med J,2(3), 68-73. https://api.semanticscholar.org/CorpusID:221756659