Prolonged disorders of consciousness: identification using the UK FIM plus FAM and cohort analysis of outcomes from a UK national clinical database

Purpose 1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. Methods Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007-2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011-2020 (n = 2384 in 68 centres). Results Cut-off points of <= 31 and 32-35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over 436,000 pound (400 pound million for this cohort). Conclusion In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme.

Automated summary

The study aims to determine if Total UK FIM + FAM scores can identify patients in VS/MCS and examine outcomes from specialist rehabilitation. The study uses retrospective analysis and multicentre cohort analysis methods, and finds that FIM + FAM scores can identify patients in VS/MCS at a population level. Additionally, those who emerge from VS/MCS generate cost-savings that exceed the cost of the evaluation/rehabilitation program.