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The WeeFIM R instrument-A paediatric measure of functional independence to predict longitudinal recovery of paediatric burn patients

The WeeFIM R instrument-A paediatric measure of functional independence to predict longitudinal recovery of paediatric burn patients

Abstract

Introduction : Burns create a myriad of complications that affect the child's developmental, functional and aesthetic status. The WeeFIM is a standardized measure of functional performance developed for use in children 6-months to 8-years of age but with application through adolescence. It includes 18 domains of performance which are scored on a 7-point scale from 'total assistance' to 'complete independence'. In this study, the WeeFIM was used to evaluate the influence of burn size on functional independence and on time to recovery. Methods : Children, 6 months to 16 years of age, with total body surface area (TBSA) burns of 10-100% burn injury were recruited for a 2-year longitudinal study. Due to unstable WeeFIM measurements on children 6 months to 6 years, analyses on normalized WeeFIM scores among subjects 6-16 years are presented. Children were evaluated at discharge from acute care, 6 months, 1 year and 2 years after burn injury. Findings : In this analysis, 454 WeeFIM evaluations from 249 patients, 6-16 years of age, were reviewed. While mean WeeFIM scores varied significantly at discharge based on the size of burn, there were no significant differences in any of the WeeFIM scales at 24 months post-burn. At 24 months, the mean WeeFIM score for all children, independent of size of their burn, indicated full independence. Hands-on assistance was not required for performing activities of daily living (ADLs). The rates of improvement differed statistically by size of burn. Maximum improvement was attained by 6 months for 10-15% TBSA burns, 12 months for 16-30% burns, 12 months for 31-50% burns and 24 months for 51-100% TBSA. Conclusion : The WeeFIM can be utilized by burn centres to describe diminished functional capacity at discharge from acute care for severely burnt children. The tool can be used to track return to baseline independence after a major burn injury in a paediatric population. Introducci n : Las quemaduras crean una serie de complicaciones que afectan al ni o en su desarrollo, en su funci n y en su apariencia. La WeeFIM es una medici n estandarizada del desempe o funcional, desarrollada para ser usada en ni os con edades de 6 meses a 8 a os, pero que tambi n puede aplicarse a lo largo de la adolescencia. Incluye 18 dominios de desempe o que son calificados en una escala de 7 puntos que abarca desde una “asistencia total” hasta una “independencia completa”. En este estudio, la WeeFIM fue usada para evaluar la influencia del tama o de la quemadura sobre la independencia funcional y sobre el tiempo de recuperaci n. M todos : Se incluyeron a ni os con edades en el rango de los seis meses a los 16 a os, con una lesi n por quemadura del 10 al 100% de quemaduras de rea de superficie corporal total (TBSA), en un estudio longitudinal de dos a os. Debido a las mediciones de WeeFIM inestables en los ni os de 6 meses a 6 a os de edad, se presenta el an lisis de las calificaciones WeeFIM normales entre sujetos de 6 a os a 16 a os. Los ni os fueron evaluados a su egreso del manejo agudo, a los seis meses, al a o y a los dos a os despu s de la lesi n por quemaduras. Resultados : En este an lisis, se revisaron 454 evaluaciones WeeFIM de 249 pacientes, con edades de 6 a 16 a os. Las calificaciones promedio WeeFIM variaron significativamente al egreso en base al tama o de la quemadura y no hubo diferencias significativas en ninguna de las escalas WeeFIM a los 24 meses despu s de la quemdura. A los 24 meses la calificaci n promedio WeeFIM para todos los ni os, independientemente del tama o de su quemadura, indic una completa independencia. No fue requerida asistencia alguna para desarrollar las actividades de la vida diaria (ADL's). Las tazas de mejor a difirieron estad sticamente de acuerdo al tama o de la quemadura. Se obtuvo una mejor a m xima a los 6 meses para quemaduras con una TBSA de 10-15%, a los 12 meses para quemaduras con un 16 a 30%, a los 12 meses para quemaduras con un 31 a 50%, y a los 24 meses para quemaduras con una TBSA de 51 a 100%. Concluiones : La WeeFIM puede utilizarse en los centros para el manejo de quemaduras con el prop sito de describir la disminuci n en la capacidad funcional al egreso del manejo agudo en ni os con quemaduras severas. El instrumento puede ser usado para realizar el seguimiento del paciente hacia su independencia, despu s de una lesi n mayor por quemadura en la poblaci n pedi trica. Palabras clave: WeeFIM , quemaduras pedi tricas , independancia , resultados , QOL , actividades de la vida diaria
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