Initial Functional Independence Measure Score and Interval Post Stroke Help Assess Outcome, Length of Hospitalization, and Quality of Care

OBJECTIVE: This study tests the hypothesis that the rehabilitation hospital admission functional Independence Measure (FIM) score and interval post stroke can be used to define clinically relevant functional recovery goals, estimate length of stay, and compare quality of care. BACKGROUND: The effects of time from stroke to rehabilitation unit admission on admission and discharge FIM scores, length of rehabilitation stay, and change in FIM score/day have not yet been reported. METHODS: Analysis was based on prospectively collected data from patients admitted to an inpatient stroke rehabilitation unit with FIM scores < or = 90 and an initial, unilateral, hemispheric, thrombotic, or embolic stroke who were fully independent without the use of an assistive device before their stroke. Patients with severe (admission FIM < 54) and moderate (admission FIM 54-90) stroke deficits were divided into cohorts based on interval from stroke to rehabilitation hospital admission: 0-2, 2-4, and 4-6 weeks. RESULTS: Over a 17-month interval, 87 patients met selection criteria. Significant improvements were seen in total FIM scores for all. For those with moderate stroke, all three time cohorts reached a FIM score of 102 +/- 2 SEM after 35 +/- 2 days on the rehabilitation unit. Patients admitted within 2 weeks of a severe stroke reached a plateau FIM score of 72 +/- 6 after 43 +/- 3 days on the rehabilitation unit compared with the 2-4 week group (FIM = 57 +/- 5 after 53 +/- 4 days) and the 4-6 week group (FIM = 54 +/- 10 after 40 +/- 6 days). Complications increased with severity of stroke and delay in rehabilitation hospital transfer. CONCLUSIONS: Admission FIM score and interval from stroke to rehabilitation hospital admission can be used to set FIM outcome goals, predict length of rehabilitation hospitalization needed to meet those goals, and compare quality of care across institutions with different referral patterns. Our results provide a benchmark against which to compare less intense or shorter duration inpatient treatment options.