Higher Functional Independence Measure Scores Research Articles

Impact of Tailored Intensive Rehabilitation on Functional Independence and Quality of Life in Brain Tumor Patients: A Prospective Observational Study

Background: Brain tumors are a heterogeneous group causing disability. They significantly impact functional independence and quality of life. This study aims to investigate how tailored intensive rehabilitation affects brain tumor patients using the functional independency measure score.
 Materials and Methods: This is a prospective observational correctional study conducted in the department of Neurophysiotherapy and Neurosurgery at Nobel Medical College Teaching Hospital, Biratnagar over a period of 18 months. A total of 96 brain tumor patients who underwent surgery at a tertiary care centerduring the study period were included. Along with the demographic data, the diagnosis ofbrain tumor functional independency was assessed using the Functional Independence Measure Index.
 Results: A total of 96 brain tumor patients (44 males, 52 females, average age 55.6 years) were studied. The tumors' distribution showed variations, with glial tumors being the most frequent (36.4%). The Functional Independence Measure (FIM) Index was used to assess functional independence, yielding an average score of 82.5. Patients with meningioma had higher FIM scores (84.3) compared to glial cell tumor patients (80.1), although not statistically significant (p = 0.122).The study also explored correlations between FIM scores, hospital stay duration (average 9 days), and patient satisfaction. A weak positive correlation (r = 0.25) existed between FIM scores and hospital stay duration.A moderate positive correlation (r = 0.65) was found between FIM scores and patient satisfaction, suggesting higher satisfaction among patients with better functional independence.
 Conclusion: Intensive rehabilitation therapy shows promise in improving functional independence in brain tumor patients.

Association of Days Alive and at Home at Day 90 After Intensive Care Unit Admission With Long-term Survival and Functional Status Among Mechanically Ventilated Patients

Many conventional end points in randomized clinical trials of interventions for critically ill patients do not account for patient-centered concerns such as time at home, physical function, and quality of life after critical illness. To establish whether days alive and at home at day 90 (DAAH90) is associated with long-term survival and functional outcomes in mechanically ventilated patients. The RECOVER prospective cohort study was conducted from February 2007 to March 2014, using data from 10 intensive care units (ICUs) in Canada. Patients were included in the baseline cohort if they were aged 16 years or older and underwent invasive mechanical ventilation for 7 or more days. The follow-up cohort analyzed here comprised RECOVER patients who were alive and had functional outcomes ascertained at 3, 6, and 12 months. Secondary data analysis occurred from July 2021 to August 2022. Composite of survival and days alive and at home at day 90 after ICU admission (DAAH90). Functional outcomes at 3, 6, and 12 months were evaluated with the Functional Independence Measure (FIM), the 6-Minute Walk Test (6MWT), the Medical Research Council (MRC) Scale for Muscle Strength, and the 36-Item Short Form Health Survey physical component summary (SF-36 PCS). Mortality was evaluated at 1 year from ICU admission. Ordinal logistic regression was used to describe the association between DAAH90 tertiles and outcomes. Cox proportional hazards regression models were used to examine the independent association of DAAH90 tertiles with mortality. The baseline cohort comprised 463 patients. Their median age was 58 years (IQR, 47-68 years), and 278 patients (60.0%) were men. In these patients, Charlson Comorbidity Index score, Acute Physiology and Chronic Health Evaluation II score, ICU intervention (eg, kidney replacement therapy or tracheostomy), and ICU length of stay were independently associated with lower DAAH90. The follow-up cohort comprised 292 patients. Their median age was 57 years (IQR, 46-65 years), and 169 patients (57.9%) were men. Among patients who survived to day 90, lower DAAH90 was associated with higher mortality at 1 year after ICU admission (tertile 1 vs tertile 3: adjusted hazard ratio [HR], 0.18 [95% CI, 0.07-0.43]; P < .001). At 3 months of follow-up, lower DAAH90 was independently associated with lower median scores on the FIM (tertile 1 vs tertile 3, 76 [IQR, 46.2-101] vs 121 [IQR, 112-124.2]; P = .04), 6MWT (tertile 1 vs tertile 3, 98 [IQR, 0-239] vs 402 [IQR, 300-494]; P < .001), MRC (tertile 1 vs tertile 3, 48 [IQR, 32-54] vs 58 [IQR, 51-60]; P < .001), and SF-36 PCS (tertile 1 vs tertile 3, 30 [IQR, 22-38] vs 37 [IQR, 31-47]; P = .001) measures. Among patients who survived to 12 months, being in tertile 3 vs tertile 1 for DAAH90 was associated with higher FIM score at 12 months (estimate, 22.4 [95% CI, 14.8-30.0]; P < .001), but this association was not present for ventilator-free days (estimate, 6.0 [95% CI, -2.2 to 14.1]; P = .15) or ICU-free days (estimate, 5.9 [95% CI, -2.1 to 13.8]; P = .15) at day 28. In this study, lower DAAH90 was associated with greater long-term mortality risk and worse functional outcomes among patients who survived to day 90. These findings suggest that the DAAH90 end point reflects long-term functional status better than standard clinical end points in ICU studies and may serve as a patient-centered end point in future clinical trials.

Outcomes of Physiotherapy on Activities of Daily Living and Discharge to the Community in Psychiatric Long-term Care Ward Patients.

The purpose of this study was to investigate the outcomes of physiotherapy on patients in psychiatric long-term care wards in Japan and to identify the characteristics of patients who have been discharged to the community. The subjects comprised 50 patients who were admitted to the psychiatric long-term care wards at four different hospitals in Japan and prescribed physiotherapy. General physiotherapy for the patients' diseases was provided. The main outcome was whether a patient was discharged to the community (discharged group) or remained hospitalized (hospitalized group) at the end of physiotherapy. Basic subject characteristics, including age, sex, F-code, classification of the diagnosis that led to physiotherapy, length of hospital stay, and length of physiotherapy, were collected from medical records. The Functional Independence Measure (FIM) tool was administered at the initial and final evaluations. At the end of physiotherapy, there were 14 subjects in the discharged group and 36 subjects in the hospitalized group. There were significant differences in the classification of diagnosis, length of stay (LOS), and classification of LOS between the two groups. Two-way analysis of variance showed interactions between the FIM subitems of self-care, transfer, and locomotion. The discharged group had higher FIM scores at the start of physiotherapy and a greater FIM gain.

Synergistic Effect of Motivation for the Elderly and Support for Going out

Maintaining a social environment that enables going out freely is important for older people and aids the prevention of frailty syndrome. However, losing a driver’s license can increase the long-term care needs of older people. Therefore, outing support systems are important. However, the utilization rate of these systems is currently relatively low. We conducted a demonstration experiment among older people aged 70 years and over, living in Iruma City, Saitama Japan, by implementing the Choisoko outing support system developed by Aisin Co., Ltd., in conjunction with an approach for improving motivation. Using this system, elderly people were able to go shopping freely whenever they chose, without a driver’s license. Participants in the demonstration experiment exhibited higher Functional Independence Measure scores after the intervention, irrespective of whether or not they used the Choisoko system. The number of uses per person increased over time, and the subjective well-being of Choisoko users improved. However, few male participants engaged with the system. Although improving motivation is important for inducing positive behaviors and enabling the elderly to go out, motivation-improving factors differ between men and women.

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit

BackgroundAge alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU).MethodsA monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables.ResultsA total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores.ConclusionsIn the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.

Healthcare utilization and costs of pediatric home mechanical ventilation in Canada.

Children using home mechanical ventilation (HMV) live at home with better quality of life, despite financial burden for their family. Previous studies of healthcare utilization and costs have not considered public and private expenditures, including family caregiver time. Our objective was to examine public and private healthcare utilization and costs for children using HMV, and variables associated with highest costs. Longitudinal, prospective, observational cost analysis study (2012-2014) collecting data on public and private (out-of-pocket, third-party insurance, and caregiving) costs every 2 weeks for 6 months using the Ambulatory Home Care Record. Functional Independence Measure (FIM), WeeFIM, and Caregiving Impact Scale (CIS) were measured at baseline and study completion. Regression modeling examined a priori selected variables associated with monthly costs using Andersen and Newman's framework for healthcare utilization, relevant literature, and clinical expertise. Data are reported in 2015 Canadian dollars ($1CAD = $0.78USD). Forty two children and their caregivers were enrolled. Overall median (interquartile range) monthly healthcare cost was $12 131 ($8159-$15 958) comprising $9929 (89%) family caregiving hours, $996 (9%) publicly funded, and $252 (2%) out-of-pocket (<1% third-party insurance) costs. With higher FIM score (lower dependency), median costs were reduced by 4.5% (95% confidence interval: 8.3%-0.5%), adjusted for age, sex, tracheostomy, and daily ventilation duration. Note: since the three cost categories did not sum to the total statistically derived median cost, the percentage of each category used the sum of median public + caregiver lost time + private out-of-pocket + third-party insurance as the denominator. For HMV children, most healthcare costs were due to family caregiving costs. More dependent children incur highest costs. The financial burden to family caregivers is substantial and needs to considered in future policy decisions related to pediatric HMV.

Nutritional Status Changes and Activities of Daily Living after Hip Fracture in Convalescent Rehabilitation Units: A Retrospective Observational Cohort Study from the Japan Rehabilitation Nutrition Database

BackgroundSeveral studies have suggested that malnutrition impedes functional recovery in patients with hip fracture, but there are few reports on improvement in nutritional status and return to activities of daily living (ADL) in these patients. ObjectiveThis study was conducted to evaluate the relationship between change in nutritional status and recovery of ADL in malnourished patients after hip fracture and to identify predictors of functional recovery among the characteristic features of undernutrition. DesignThis was a retrospective observational cohort study. Participants/settingData for patients aged ≥65 years with hip fracture and malnutrition (Mini Nutritional Assessment–Short Form [MNA-SF] score ≤7) at the time of admission to convalescent rehabilitation units were obtained from the Japan Rehabilitation Nutrition Database between November 2015 and August 2017. Main outcome measuresThe main outcome measures were Functional Independence Measure (FIM) at discharge and the proportion of patients discharged home. Statistical analyses performedPatients were divided into two groups based on MNA-SF scores at discharge: improvement in nutritional status (>7, IN group) and non-improvement in nutritional status (≤7, NN group). Clinical characteristics and outcomes were compared between the groups. Multivariable regression analysis was performed to adjust for confounders including age, sex, comorbidity, pre-fracture ADL level, and FIM score on admission. ResultsOf 876 patients, 110 met the eligibility criteria (mean age, 85 years; 78.2% female); 77 of the patients were assigned to the IN group and 33 to the NN group. The patients in the IN group were younger and had higher FIM and MNA-SF scores on admission than those in the NN group. At discharge, the median FIM score was significantly higher in the IN group than in the NN group (110 vs 83, P<0.001). Multivariable analysis revealed a significant association between improvement in nutritional status and higher FIM score at discharge (B=7.377 [B=partial regression coefficient], P=0.036) but no association with discharge to home. Mobility, neuropsychological impairment, and weight loss subscores of MNA-SF were independently associated with discharge FIM score (R2=0.659). ConclusionsIn older patients with hip fracture and malnutrition, improvement in nutritional status was independently associated with improved performance of ADL during inpatient rehabilitation. Weight loss may be an important nutritional indicator for these patients.

Time use and physical activity in a specialised brain injury rehabilitation unit: an observational study

ABSTRACTObjectives: To determine what is the use of time and physical activity in people undertaking inpatient rehabilitation in a specialised brain injury unit. To determine participants’ level of independence related to the use of time and physical activity.Methods: Design: Cross-sectional observation study. Participants: Fourteen people [mean (SD) age 40 (15) years] with brain injuries undertaking inpatient rehabilitation. Procedure: Participants were observed every 12 minutes over 5 days (Monday to Friday from 7:30 am until 7:30 pm) using a behaviour mapping tool. Outcome measures: Observation of location, people present, body position and activity engaged in (both therapeutic and nontherapeutic). Functional Independence Measure (FIM) scores were determined for each participant.Results: Participants spent a large part of their time alone (34%) in sedentary positions (83%) and in their bedrooms (48%) doing non-therapeutic activities (78%). There was a positive relationship between a higher level of independence (higher FIM score) and being observed in active body positions (r=0.60; p=0.03) and participating in physically active therapeutic activities (r=0.53; p=0.05).Conclusion: Similar to stroke units, inpatients in a specialised brain injury unit spend large parts of the day sedentary, alone and doing non-therapeutic activities. Strategies need to be evaluated to address this problem, particularly for people with greater physical dependence.

Improved functions and reduced length of stay after inpatient rehabilitation programs in older adults with stroke: A systematic review and meta-analysis of randomized controlled trials.

to examine the effects of inpatient rehabilitation programs on function and length of stay in older adults with strokeMETHODS: A total of five electronic databases were searched for relevant randomized controlled trials that examined the effects of inpatient rehabilitation programs on functional recovery, as measured by the functional independence measure and length of stay, which was measured in days. We included full-text articles written in English, and no time limit. The methodological quality and risk of bias were assessed using the Physiotherapy Evidence Database Scale and the Cochrane collaboration tools respectively. The effect sizes and confidence intervals were estimated using fixed-effect modelsRESULTS: Eight randomized controlled trials involving 1,910 patients with stroke were included in the meta-analysis showed that patients who participated in the inpatient rehabilitation programs had significantly (p less than 0.05) higher functional independence measure scores (effect size = 0.10; 95 percent confidence interval = 0.01, 0.22) and shorter length of stay (effect size = 0.14; 95 percent confidence interval = 0.03, 0.22). This systematic review provided evidence that inpatient rehabilitation programs have beneficial effects, improving functionality and reducing length of stay for older adults with stroke.

Long-Term Efficacy of Rehabilitation Following Arthroscopic Synovectomy in Patients With Rheumatoid Arthritis Treated With Biologic Agents.

ObjectiveTo investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents.MethodsArthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes.ResultsThe increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X).ConclusionRehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.

Higher Charlson Comorbidity Index scores do not influence Functional Independence Measure score gains in older rehabilitation patients

To assess the effect of age-adjusted Charlson Comorbidity Index (CCI) score on Functional Independence Measure (FIM) score gain in older rehabilitation patients. This prospective cohort study observed 306 older rehabilitation patients admitted to a secondary hospital between February and April 2015. Groups were compared using CCI score cut-offs of ≤4, 5-6 and ≥ 7. Complete FIM data were available for 280 patients. The mean age-adjusted CCI score was 5.59±1.96. An age-adjusted CCI score ≤4 correlated with higher FIM scores at admission P=0.015, and discharge P=0.002, but not with a greater gain in FIM score P=0.067. There were no significant between-group differences in mortality, hospital transfers or length of stay. The Charlson age-comorbidity index was not a prognostic marker for FIM gain. Age and comorbidity alone are not barriers to the rehabilitation of older patients.

Association between the Functional Independence Measure following spinal cord injury and long-term outcomes

Retrospective cohort. To estimate the association between the Functional Independence Measure (FIM) for spinal cord injury (SCI) patients at time of discharge from rehabilitation and long-term resource utilization, residential status and employment. The intention was to assess the value of FIM for projecting economic burden in SCI. Federally designated spinal cord injury model system facilities throughout the USA. We analyzed data from the National Spinal Cord Injury Statistical Center database (n = 14 620) (1988-2010), excluding subjects with: age < 6 years, normal motor function, death before discharge or etiology from gunshot or penetrating wound (n = 11685 retained). We investigated the association between motor FIM at rehabilitation discharge and residential status, survival and outcomes at 1, 5, 10, 15 and 20 years follow-up, including FIM, residential status, hospitalizations, days hospitalized in previous year, daily paid and total care and paid hours worked. Regression controlled for injury completeness, neurological level, demographic characteristics and temporal effects. All outcomes were statistically associated with higher FIM scores at discharge. Each one-point increment in FIM was associated with improvements in: probability of institution care at discharge (-0.34%) and at follow-up (-0.13%), FIM score at follow-up (0.76 points), hospitalizations and days hospitalized/year (-0.0044 and -0.071, respectively), probability of needing paid assistance (-0.72%) or any assistance (-0.85%) and probability of paid work (0.41%). The FIM at discharge has predictive value for long-term outcomes. Improvement in FIM suggests reduced economic burden in SCI patients. Novartis Pharmaceuticals Corporation.

Predictors of the Length of Stay of Inpatients in Rehabilitation Setting After Traumatic Spinal Cord Injury

Predictors of the Length of Stay of Inpatients in Rehabilitation Setting After Traumatic Spinal Cord Injury

Functional outcome and discharge destination in elderly patients with spinal cord injuries

Retrospective cohort study. To describe functional outcome and discharge destination of elderly patients with traumatic spinal cord injuries. National Spinal Injuries Unit, Glasgow, UK. We collected data for 5 years on all patients >65 years old with a traumatic spinal cord injury treated at the National Spinal Injuries Unit. We identified 39 patients. Of these, nine patients died during admission; all had cervical spine injuries. The mean age of the 30 survivors was 73 years (range 65-88). The most common cause of injury was a fall: 26 patients (87%). In addition, 21 (70%) sustained injury to cervical cord, 3 (10%) had thoracic and 6 (20%) had lumbar spine fractures. In all, 23 patients (77%) were treated by orthosis and 7 (23%) underwent surgical intervention. Twelve (40%) patients showed an improvement in American Spinal Injury Association impairment scale. The median hospital stay was 136 days. Thus, 11 patients (37%), all with incomplete injuries, were discharged home, 10 (33%) were transferred to nursing homes/community hospitals and 9 patients (30%) were discharged back to the referring hospital, while they were awaiting adjustments at home. Patients who were discharged home had significantly higher Functional Independence Measure scores, both at the onset of rehabilitation and at discharge, than those who were discharged to a nursing home or other hospitals (P<0.01 and <0.001, respectively). Although the elderly patients may benefit from the services of a dedicated spinal injuries centre, they should be carefully selected. The patient, relatives as well as the referring doctors should be alerted to the likely long-term outcomes early in the course of the injury. Elderly patients with complete lesions of the spinal cord will almost certainly remain institutionalized. Early endeavour should be made to find alternate rehabilitation settings with a lower-intensity treatment.

Civilian spinal cord injuries due to terror explosions

Retrospective analysis of civilians with spinal cord injuries (SCIs) due to terror explosions. To analyze and describe the clinical characteristics and rehabilitation outcomes of civilians with SCI due to explosions admitted for in-patient rehabilitation from 2000-2004. SCI rehabilitation service, Tel Hashomer, Israel. Retrospective chart review. Civilians with SCI due to terror-related gunshot wounds (GSWs) served as a control group. Eleven civilians with SCI caused by penetrating atypical foreign objects (PAFOs) and eight with GSWs were identified. The male-to-female ratio was approximately 2:1. Foreign objects were present within the spinal canal in seven patients, causing bone injury without canal penetration in three, and one patient had both bone injury and canal penetration. The most common level of injury was thoracic. Seven had complete motor SCI. Three individuals improved in American Spinal Injury Association status: one individual improved from B to C (cervical); one from C to D (thoracic); and the third from D to E (lumbar). Despite the similar acute hospital length of stay and functional independence measure (FIM) scores on admission, the PAFO group had a shorter rehabilitation length of stay with higher FIM scores and higher FIM efficiency at discharge. Although the pathophysiology of PAFO blast injuries is similar to the high-velocity GSWs or the high-energy military munition injuries, better rehabilitation outcomes were seen, with slightly higher FIM efficiency and efficacy at discharge. This result is likely to be caused by less neurological tissue damage at impact.

Predictors of functional independence in elderly patients with heart failure

Objective: The aim of this study was to identify the functional independence predictors in elderly patients with heart failure (HF). Design and Methods: Exploratory, descriptive and transversal study with 146 elderly outpatients with heart failure referred to hospitals in São Paulo. Two instruments were used for the data collection: the Sociodemographic and Clinical Instrument and The Functional Independence Measure (FIM). Descriptive and comparative statistical analyses were used (Kruskal-Wallis), as well as univariate and multiple regression analyses. Results: 52.0% of the patients were males, with a mean age of 68.6 (±6.9) years and 3.4(±2.8) years of education, with 3.9 (±1.7) comorbidities, 3.5 (±1.4) symptoms, with a predominance of NYHA class I or II (65%) and 67% with decreased left ventricular ejection fraction (LVEF). High FIM scores were observed, demonstrating the functional independence of the studied patients. The comparison between FIM scores and NYHA classes showed that a worse FIM score correlated with a progression in the NYHA class. The multiple regression analysis showed that the NYHA classes, years of education and age older than 80 years were predictors of functional independence, explaining 35.0% of the FIM variability. Conclusion: The variables NYHA class, age older than 80 years and higher level of education were predictors of functional independence and this fact suggests the importance of interventions that favor the detection

Functional independence in persons with spinal cord injury in Helsinki.

To estimate the functional independence of persons with spinal cord injury according to the Functional Independence Measure motor items. The study design was cross-sectional. All adult citizens of Helsinki with traumatic spinal cord injury were identified. The final study group consisted of 121/152 subjects (80%). Functional Independence Measure assessments and American Spinal Cord Association examinations were performed on all subjects by the same experienced group including a physician and a physiotherapist. The most assistance-craving items were climbing stairs and bladder management. There were no significant differences between the genders. Subjects with tetraplegia needed significantly more assistance in all motor items except walking/wheelchair locomotion, where there was no significant difference. Subjects with tetraplegia in American Spinal Injury Association Impairment Scale D had higher Functional Independence Measure scores, more functional independence, than subjects in American Spinal Injury Association Impairment Scale A-C, the difference being significant. Because of new information, the results of this study may provide better possibilities for planning and coordinating rehabilitation measures and social services.

Rehabilitation of cognitive and motor functions in younger and older patients with vascular brain damage, rheumatologic illness and in post-surgery patients

This study presents results of inpatient rehabilitation (as monitored by Functional Independence Measure (FIM)) of patients with vascular brain damage (n = 78), post surgery patients (n = 62) and of patients with rheumatologic illness (n = 45). These patients were divided into two age groups (cut off point 65 years). There were significant differences in the FIM scores in all three diagnosis groups between the younger and the older patients at discharge, the younger patients reaching a higher FIM score. However, there were no substantial differences between the two age groups in FIM gains the length of stay in any of the diagnosis groups. This study indicates that although younger patients reach higher FIM score at admission and at discharge the patients older than 65 improved in a comparable way during the same length of stay thus requiring comparable financial resources.

Inpatient rehabilitation

All admissions to an acute rehabilitation unit were later critiqued by the rehabilitation team to determine appropriateness of admissions. The physiatrist alone evaluated the patient for admission. From the team which worked with the patient, a physical therapist, occupational therapist and a nurse were asked to evaluate the appropriateness of the admission; a decision on appropriateness had to be supported by at least two of these three. The team scored patients with the Functional Independence Measure (FIM) on admission, weekly, and at discharge. In a six-month period there were 60 appropriate admissions and ten inappropriate admissions. The average length of stay was 38.3 days for appropriate and 17.3 days for inappropriate admissions. The appropriate gorup had an average initial FIM score of 40.6 and discharge score of 66.6. The inappropriate group started with high FIM scores, with an average of 61.0, and did not significantly improve their scores. Their average discharge score was 70.0. The rate of progress (efficiency ratio), in points per day, was 0.81 for the appropriate and 0.36 for the inappropriate group. Thus, there is a strong positive correlation between the rate of progress and appropriateness as assessed at discharge by the multidisciplinary team [corrected].