Predicting outcome after acute stroke with the Functional Independence Measure

Previous studies attempting to predict outcome after acute stroke have been limited by small sample sizes and inconsistent definitions of outcome. The functional status data from the Functional Independence Measure (FIM) as well as social and demographic information from 2,109 stroke survivors were reviewed to determine the possible risk factors for poor outcome. Four measures of outcome were used for this analysis: discharge placement, rate of change of functional status as measured by the FIM, total change in functional status from admission to discharge, and length of stay. The most significant risk factor for discharge to a location other than home was an admission FIM score of less than 60; the relative risk was 3.5. Several other factors, including race, marital status, and age, influenced this outcome. A low admission FIM score was also a significant risk factor for a low rate of change of functional status during the inpatient rehabilitation stay; the relative riskwas 2.2. A low admission FIM score was the most predictive factor but still enabled only poor prognostication for an individual patient.