Application of functional independence measure in the rehabilitation of military servicemen wounded during war operations in Ukraine

Abstract

Background

In the structure of military traumatism, the number of multiple and combined wounds and injuries has increased significantly due to the increase in the destructive properties of modern weapons. Most blast wounds are characterized by multiple damage to blood vessels and nerve fibers and significant defragmentation of muscles and skin. All such wounds are considered initially infected, which is an additional aggravating factor. The establishment of a correct rehabilitation diagnosis and subsequent stage-by-stage assessment of the results of rehabilitation therapy should be based on adequate functional assessment tools. The FIM is one such tool that had not been previously recommended for use in any Ukrainian guideline.

Objective

The aim of the study was to investigate the possibility of using the Functional Independence Measure as an additional tool for assessing the effectiveness of rehabilitation of military personnel in Ukraine with combined injuries over a long period of time.

Material and Methods

A retrospective study was conducted of 807 wounded Ukrainian servicemen with complex injuries of varying severity. Examination included a meticulous analysis of medical records, a comprehensive physical examination, and a survey using the 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 examined wounded had an initial assessment of more than 6 points on the FIM scale. Initial data in the assessment of functioning on the FIM scale allowed the identification of two different subgroups of patients: one with a predominance of motor function impairment, and the other, predominant cognitive impairment. Reliable positive changes of the total FIM indicator were observed in all patient groups. The primary improvement in the groups with traumatic brain injury (TBI) was attributed to enhancements in cognitive abilities. Patients with the lowest initial motor abilities (combined upper and lower extremity trauma group) demonstrated the highest increase in this area.

Conclusions

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 rehabilitation results.