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Functional gains during acute hospitalization for stroke.

Richard W Bohannon1, Martha Ahlquist, Nora Lee

  • 1Institute of Outcomes Research and Evaluation, Hartford Hospital, 80 Seymour St, P.O. Box 5037, Hartford, CT 06102-5037, USA. rbohann@harthosp.org

Neurorehabilitation and Neural Repair
|September 25, 2003
PubMed
Summary

Five Functional Independence Measure (FIM) items effectively measure patient recovery after stroke. Functional independence improved during hospitalization, with therapy units weakly predicting outcomes.

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Area of Science:

  • Rehabilitation Medicine
  • Neuroscience
  • Clinical Measurement

Background:

  • Assessing functional independence is crucial for stroke patient recovery.
  • The Functional Independence Measure (FIM) is a widely used tool, but its suitability for specific items needs validation.
  • Understanding factors influencing functional change is key to optimizing rehabilitation.

Purpose of the Study:

  • To validate the clinimetric properties of five specific Functional Independence Measure (FIM) items for assessing functional independence in acute stroke patients.
  • To describe changes in functional independence during hospitalization.
  • To identify variables associated with functional independence at discharge and functional change.

Main Methods:

  • A cohort of 451 acute stroke patients had scores recorded for five FIM items (transfers, eating, walking, expression, memory) at admission and discharge.

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  • The sum of the five FIM items was calculated to represent overall functional independence.
  • Functional change was determined by the difference in scores between admission and discharge.

    • Main Results:

    • The five FIM items demonstrated strong internal consistency (alpha = .894 and .918) and measured a single underlying factor.
    • Patients showed a statistically significant increase in functional independence over a mean of 5.5 days (t = 17.46, P < .001).
    • Regression analysis indicated that admission function, NIHSS score, length of stay, age, and total therapy units were significant predictors of discharge function (R2 = .804) and functional change (R2 = .184).

    Conclusions:

    • Five easily observable FIM items are suitable for characterizing functional independence in acute stroke patients.
    • Functional independence significantly increases during acute hospitalization.
    • While several factors predict functional outcomes, total therapy units showed a significant but weak association with discharge function and functional change.