Discharge FIM Scores Research Articles

Influence of medical comorbidities and complications on FIM change and length of stay during inpatient rehabilitation.

This study was performed to evaluate the influence of medical problems on functional outcome measures of patients admitted for comprehensive inpatient rehabilitation. In this retrospective database review of patients, demographic information, length of stay, FIM scores at admission and discharge, and FIM efficiency were collected and analyzed. Preexisting comorbidities and acute medical complications of all patients were identified, tabulated, and analyzed. A total of 175 patients were categorized into three major groups. In the postorthopedic surgery group, the presence of preexisting medical comorbidities did not significantly affect admission or discharge FIM scores. In contrast, traumatic brain injury patients with preexisting medical comorbidities had a tendency to be admitted and discharged with lower FIM scores. However, traumatic brain injury patients with acute medical complications still made reasonable functional improvement during their extended stay, so that their FIM efficiency was adequately maintained. In the cerebrovascular accident group, almost all patients had preexisting medical issues. The rehabilitation population is diverse, and functional outcome measures for distinct disease entities may be differentially affected by factors such as preexisting medical comorbidities and acute medical complications. Except for life-threatening medical emergencies, rehabilitation patients may benefit by staying on the acute rehabilitation unit, where both medical management and a comprehensive rehabilitation program are provided with continuity.

FIM after hip fracture: is telephone administration valid and sensitive to change?

It has been reported recently that follow-up FIM trade mark scores have been obtained from stroke patients via telephone interviews with either the former patient or proxy caregivers. We studied the validity and sensitivity of change of a "phone FIM" score in a sample of hip fracture patients after rehabilitation. We compared FIM scores among hip fracture patients in a specialized musculoskeletal rehabilitation program. Sample size estimate of 27 was determined before the study. Patients included those with hip fracture returning to independent living in their own home. Twenty-nine patients were identified as a convenience sample of admitted patients. The phone FIM score at 8 wk was a valid predictor of the discharge FIM score and the observed FIM and phone FIM scores at 8 wk were similar. The sensitivity to change over 8 wk was similar between observed and phone FIM scores compared with the discharge FIM score. The phone FIM instrument presents a useful clinical instrument to monitor patient functional status in the community, showing excellent psychometric properties. Ease of use and low cost should encourage greater use in clinical management of these patients.

Stroke rehabilitation: indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes.

The aim of this study was to investigate the associations between tracheostomies, enteral feeding tubes, and indwelling urinary catheters and functional outcome measures, incidence of medical complications, and resource use in an inpatient stroke rehabilitation program. A cohort of 1553 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke characteristics, impairment (National Institutes of Health Stroke Scale) and disability level (Functional Independence Measure [FIM]), preexisting medical conditions, and the presence of tracheostomies, enteral feeding tubes, and indwelling urinary catheters were recorded at admission. The occurrence of medical complications during rehabilitation, discharge disability level, length of rehabilitation stay, and rehabilitation hospital charges were recorded at discharge. Compared with patients with no medical tubes, patients with 3 medical tubes had significantly higher National Institutes of Health Stroke Scale scores, lower admission and discharge FIM scores, reduced FIM efficiency scores (average FIM score change per day), and twice the number of medical complications. Patients with 3 medical tubes stayed 28 days longer in acute hospitalization and 20 days longer in rehabilitation compared with patients with no medical tubes. The presence of even a single medical tube was associated with longer length of stay, more medical complications during rehabilitation, and greater disability level at discharge. The presence of > or =1 medical tubes is associated with more severe and disabling strokes, an increased number of medical complications, longer acute and rehabilitation hospitalizations, and greater resource use.

Functional outcome after inpatient rehabilitation in persons with subarachnoid hemorrhage

O'Dell MW, Watanabe TK, De Roos ST, Kager C. Functional outcome after inpatient rehabilitation in persons with subarachnoid hemorrhage. Arch Phys Med Rehabil 2002;83:678-82. Objectives: To describe inpatient rehabilitation outcome in persons with nontraumatic subarachnoid hemorrhage (SAH) and to explore the predictive capacity of acute measures of SAH severity and demographic and disease variables. Design: Retrospective with descriptive and relational analyses. Setting: Free-standing, acute, inpatient brain injury rehabilitation unit. Participants: Forty-two consecutive persons with nontraumatic SAH and for whom complete data were available were studied. Mean age of the group was 56.5 years, mean acute hospital stay was 26.2 days, and 60% were women. Over 40% experienced rupture of an anterior communicating artery aneurysm. The time from injury to rehabilitation admission varied from 11 to 227 days (mean, 43.8d). Interventions: Not applicable. Main Outcome Measure: Change in FIM™ instrument scores, home discharge rate, and rehabilitation length of stay (LOS.) Results: The mean admission and discharge FIM scores were 57.7 and 85.5 points, respectively. There was a 27.8-point mean change in FIM score over a 24.1-day mean rehabilitation LOS for a FIM efficiency (points/day) of 1.15. Over 80% of the sample was discharged home. No demographic or disease characteristic variables, including acute severity measures, were statistically significant predictors of outcome. Conclusions: Functional gains during inpatient rehabilitation made in this group of 42 persons with SAH are in line with earlier studies. Our rehabilitation LOS is the shortest reported among 4 studies to date and is probably a reflection of managed care in the United States. A small sample, uneven cell sizes, and variability of patients might have contributed to a lack of significant findings. Future study should explore the prediction of rehabilitation outcome using larger sample sizes and longer follow-up periods. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program

Sansone GR, Alba A, Frengley JD. Analysis of FIM instrument scores for cardiac patients admitted to an inpatient rehabilitation program. Arch Phys Med Rehabil 2002;83:506-12. Objective: To evaluate in an inpatient cardiac rehabilitation program (a phase IB) whether length of stay (LOS), discharge to home, and improvement in physical function differed between patients with lower and higher degrees of functional independence on admission. Design: A retrospective study. Setting: A public acute long-term care hospital. Patients: All cardiac rehabilitation patients (N = 143) admitted to the hospital from January 1998 through June 1999. Patients were divided into a higher- and a lower-functioning group by using the admission FIM instrument scores above and below the midpoint of 72. Comparisons in LOS, discharge disposition, and functional gains between these 2 groups were then performed. Interventions: Not applicable. Main Outcome Measures: FIM scores, FIM change, FIM gains per week, LOS, and discharge disposition. Results: Total FIM scores at discharge were significantly higher than those on admission (25%, P <.0001). The median value of total FIM gains per week was 7.78 with a stay of 17 days and a home discharge rate of 76%. The higher-functioning group (n = 106) differed from the lower group (n = 37) with shorter stay (15 vs 23d, P <.0001), greater FIM gains per week (8.6 vs 4.8, P =.002), and greater likelihood of discharge to home or community (84% vs 54%, P <.001). The average incremental FIM change in each group was the same. In multivariate analysis, both admission (P =.001) and discharge (P <.001) FIM scores were the best predictors of patients' discharge disposition to home. Conclusions: Admission FIM scores are important predictors for the clinical course and discharge outcomes of cardiac rehabilitation patients, with those with higher admission FIM scores having a shorter LOS and greater likelihood of discharge to home. The admission FIM scores can help to establish realistic goals. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Inpatient interdisciplinary rehabilitation after total hip arthroplasty surgery: A comparison of revision and primary total hip arthroplasty

Walker WC, Keyser-Marcus LA, Cifu DX, Chaudhri M. Inpatient interdisciplinary rehabilitation after total hip arthroplasty: a comparison of revision and primary total hip arthroplasty. Arch Phys Med Rehabil 2001;82:129-33. Objectives: To describe outcomes of revision total hip arthroplasty (THA) patients who underwent interdisciplinary inpatient rehabilitation, and to compare them with primary THA patients. Design: Descriptive and case-control study. Setting: Forty-bed, community-based, freestanding rehabilitation hospital. Patients: Thirty-nine revision THA subjects, gender- and age-matched with 39 primary THA controls. Intervention: Inpatient interdisciplinary rehabilitation. Main Outcome Measures: FIM™ instrument, length of stay, hospital charges, and disposition location. Results: The average revision THA patient stayed 10.5 days, improved from an admission FIM score of 89 to a discharge FIM score of 110, and incurred a hospital charge of $10,600. Of the revision THA patients, 98% were discharged home, and orthopedic-related complications were uncommon. No significant differences existed between revision and primary THA patients in any outcome measures. A trend toward higher rehabilitation charges ($12,400 vs $9500, p =.07) was found in revision THA patients who wore a hip orthosis. Otherwise, no differences were found in outcome measures based on the type of revision surgery, the presence of weight-bearing restrictions, or the presence of orthopedic complications. Conclusions: THA patients selected for inpatient rehabilitation have favorable short-term functional outcomes. The type of THA (primary vs revision) is not an independent differentiating factor. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Correlation of functional independence measure FIM with SPECT Iofetamine I123 as a predictor of functional return in stroke

Function following stroke is often measured using the Functional Independence Measure FIM. Independence occurs when the patient achieves certain levels of function. SPECT imaging assesses the regional cerebral blood flow rCBF. Is it possible to correlate the FIM scores with SPECT imaging and predict functional return? We evaluated total of 69 stroke patients with SPECT imaging using Iofetamine I-123. Patients were scanned within 14-21 days post-stroke. CT scans were evaluated and correlated with the SPECT images. This information was compared with the admission and discharge FIM scores. The rCBF reperfusion changes and region of stroke were evaluated and correlated with discharge functional status. The right parietal areas demonstrated a strong correlation with SPECT and FIM changes as predictors of return to functional living status p-value 0 0438. The right parietal area demonstrated an improvement in ambulation p-value 0 0578 ; the right brain correlated with overall improvement in FIM scores and change in SPECT imaging p-value 0 0833 ; the left brain did not exhibit significant values. Our conclusion was that there were trends seen with the predictive value of stroke recovery using SPECT imaging. The current sample number was not large enough to provide an adequate study, especially for the left brain; a larger study is needed. This information could be useful to help determine patient placement for rehabilitation.

The influence of age on length of stay, functional independence and discharge destination of rehabilitation inpatients in Italy.

Advanced age in itself does not predict a poor functional outcome or a longer length of stay in rehabilitation units. Seven hundred and sixty-four adult cases were analysed, from 14 post-acute rehabilitation facilities throughout Italy. Data came from the national database run by the agency distributing the Italian version of an internationally validated scale of disability, the FIM [symbol: see text] sm (Functional Independence Measure). The FIM is an 18-item scale rating independence in the domains of selfcare, sphincter control, mobility, locomotion, communication and social cognition. The total FIM score may range from 18 to 126 (higher score = greater independence). Patients were classified with respect to the cut-off age of 75 years (76+ and 75-, mean age 82 and 57 years, n = 203 and 561, 27% and 73% of the cases, respectively). The median interval between onset of disability and admission to the facility (onset-to-admission delay, OAD) was 36 and 45 days in the 76+ and the 75- group, respectively (p < 0.001). Mean admission FIM score was 70 (+/- 28) in the 76+ and 71 (+/- 27) in the 75- group. Discharge FIM scores were 84 +/- 29 and 93 +/- 26, respectively (p < 0.001). Median length of stay (LOS) was 34 days in the 76+ and 41 days in the 75- group, respectively (p < 0.005). The 76+ and 75- groups were discharged home in 86% and 90% of the cases, respectively (p = 0.053). The results suggest that inpatient rehabilitation is substantially effective and efficient for older as well as for younger patients.

Metastatic and Traumatic Spinal Cord Injury: Acute Rehabilitation Outcome, Post-Discharge Placement, and One Year Survival

Paraplegia following metastatic spinal damage is associated with specific problems that require expert attention and management. Out of 744 consecutive admissions to a Spinal Cord Injury Unit, the acute rehabilitation outcomes, the post-discharge place ments, and the one-year survival rates of twenty patients with metastatic spinal cord lesions (MSCL) were compared to twenty-four patients with traumatic spinal cord injury (TSCI) in the same age range and level of neurologic injury.The rehabilitation outcome was measured using the Functional Independence Mea sure scores, the efficiency and the efficacy scores, and the length of stay in the inpatient rehabilitation unit.Although the average FIM scores at admission were higher in the MSCL group (70 vs. 65.63), their discharge FIM scores were lower than in the TSCI group (88.28 vs. 96.1). The efficacy score was significantly worse in the MSCL group ( p = .01) and there was no significant difference in efficiency between both groups.The median length of stay w...

Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges

Objective: To determine the relationship between early variables (initial Glasgow Coma Scale [GCS] scores, computed tomography [ct]findings, presence of skeletal trauma, age, length of acute hospitalization) and outcome variables (Functional Independence Measure [FIM] scores, rehabilitation length of stay [LOS], rehabilitation charges) in traumatic brain injury (TBI). Design: Inception cohort. Setting: University tertiary care rehabilitation center. Patients: 91 patients with TBI. Interventions: Inpatient rehabilitation. Main Outcome Measures: FIM, rehabilitation LOS, and rehabilitation charges. Results: Patients in the severely impaired (GCS = 3 to 7) group showed significantly lower ( p = .01) mean admission and discharge motor scores (21.26, 39.83) than patients in the mildly impaired (GCS = 13 to 15) group (38.86, 55.29). Cognitive scores were also significantly lower ( p < .01) in the severely impaired group on admission (26.73 vs 54.14) and discharge (42.28 vs 66.48). These findings continued to be statistically significant ( p < .01) after regression analysis accounted for the other early variables previously listed. Regression analysis also illustrated that longer acute hospitalization LOS was independently associated with significantly lower admission motor ( p < .01) and cognitive ( p = .05) scores, and significantly higher ( p = .01) rehabilitation charges. Patients with CT findings of intracranial bleed with skull fracture had longer total LOS (70.88 vs 43.08 days; p < .05), rehabilitation LOS (30.01 vs 19.68 days; p < .10), and higher rehabilitation charges ($43,346 vs $25,780; p < .05). Paradoxically, those patients in a motor vehicle crash with an extremity bone fracture had significantly higher ( p = .002; p = .04 after regression analysis) FIM cognitive scores on admission (48.30 vs 27.28) and discharge (64.74 vs 45.78) than those without a fracture. Finally, data available on rehabilitation admission were used to predict discharge outcomes. The percentage of explained variance for each outcome variable is as follows: discharge FIM motor score, 69.5%; discharge FIM cognitive score, 71.2%; rehabilitation LOS, 54.1%; rehabilitation charges, 61.1%. The most powerful predictor of LOS and charges was the admission FIM motor score ( p < .001), followed by CT findings ( p = .02) and age ( p = .04). Conclusion: Information readily available on rehabilitation admission, particularly the FIM motor score, may be useful in predicting discharge FIM scores as well as utilization of medical rehabilitation resources. Earlier transfer to rehabilitation may result in higher functional status and lower rehabilitation charges, as well as lower acute hospitalization charges. The presence of extremity fractures encountered during a motor vehicle crash is associated with a more favorable outcome in TBI as evidenced by higher discharge FIM cognitive scores.