FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture
Wang, C-Y., Graham, J. E., Karmarkar, A. M., Reistetter, T. A., Protas, E. J., & Ottenbacher, K. J. (2014). FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture. PM and R, 6(6), 493-497. DOI: 10.1016/j.pmrj.2013.12.008
OBJECTIVE: To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture.
DESIGN: Retrospective cohort study.
SETTING: A total of 1257 inpatient rehabilitation facilities in the United States.
PATIENTS: Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009.
METHODS: Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting.
MAIN OUTCOME MEASUREMENTS: Discharge setting (community versus institutional).
RESULTS: Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting.
CONCLUSIONS: Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.