Functional independence measure analysis in patients undergoing phase I of cardiac rehabilitation

Abstract

Purpose: Previous analysis of the Functional Independence Measure (FIM) scale in patients with chronic heart disease have given little consideration to scores during the acute phase of cardiac rehabilitation (CR). Our objective was to determine whether discharge FIM score at acute phase (phase I) CR can predict subsequent patient discharge to their home (as opposed to another destination at discharge); the FIM cutoff score that best predicted discharge home was calculated. Methods: This study included 1015 patients enrolled during a 24-month period from January 2010 through December 2011. Criteria for participating in CR included acute myocardial infarction, cardiovascular surgery, and others. The measurement items were FIM score at starting of CR and at discharge, length of stay (LS), and CR discharge outcome (discharge to home or other). Furthermore, data on age, sex, and presence of heart failure at admission were also obtained. In a multiple logistic-regression analysis, home discharge was set as a dependent variable. All other data were adopted as independent variables. The FIM cutoff score for discharge home was determined using receiver-operating characteristic (ROC) curve analysis, and the area under the curve (AUC) was calculated using the ROC curve. This research was approved by the Ethics Committee of our institution. Participants provided informed consent in accordance with the principles of the Declaration of Helsinki. Results: Home discharge was possible for 760 people (74.9%); the remaining 255 (25.1%) had other destinations at discharge. After regression analysis, FIM at discharge, LS, and presence of heart failure were extracted as prediction factors (Table). The capability of the regression model to correctly predict discharge home was 88.0%. ROC curve analysis determined the FIM cutoff point to be 100.5 points at discharge, with an AUC of 0.918. View this table: Prediction Factors for Home Discharge Conclusion: Discharge FIM score at phase I CR may be the strongest predictor of a patient subsequently being discharged home (rather than to another destination); the FIM cutoff score was 101 points.