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Motor and cognitive function analysis for home discharge using the Functional Independence Measure in patients
N Sasanuma1, K Takahashi, Y Itani
1Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan - naoki.sasa@gmail.com.
Background:
Although numerous studies on Functional Independence Measure (FIM) analysis in stroke, orthopedic disease, and spinal cord injury patients have been conducted, it has rarely been done in patients undergoing cardiac rehabilitation (CR).
Aim:
To verify whether the Functional Independence Measure (FIM) score, and its subscale motor FIM and cognitive FIM, during inpatient CR can be a predictor of a patient's readiness for home discharge by establishing an FIM cutoff value.
Design:
A retrospective, observational cohort study
Setting:
This study was conducted at a long-term acute-care hospital.
Population:
Participants were in-hospital patients undergoing CR (N.=949).
Methods:
Measurements included motor FIM, cognitive FIM, CR period, FIM gain per week, and discharge disposition. The strongest predictor for home discharge was analyzed by using multiple logistic regression analysis, and the cutoff value of the FIM score for home discharge was determined by using receiver operating characteristic (ROC) curves.
Results:
Discharge to home was possible in 723 patients (76.2%), whereas 226 patients (23.8%) had other outcomes. In univariate analysis, a motor FIM gain per week of five points was achieved in the home discharge group. Multiple logistic regression analysis revealed that Body Mass Index, number of comorbidities, motor FIM at discharge, cognitive FIM gain, and CR period were predictive factors with 89.6% predictive ability. ROC curve analysis showed that the cutoff value was a discharge motor FIM score of 63/64 points with 0.912 areas under the curve.
Conclusion:
Discharge motor FIM and cognitive FIM gain were predictive factors for home discharge. A motor FIM gain per week of five points and discharge motor FIM score of 64 points at the end of inpatient CR may be important predictors of a patient's readiness for discharge to home.
Clinical Rehabilitation Impact:
The findings of this study indicate an alternative goal to the activities of daily living in inpatients with cardiovascular disease.
