Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program

Objective: To evaluate in an inpatient cardiac rehabilitation program (a phase IB) whether length of stay (LOS), discharge to home, and improvement in physical function differed between patients with lower and higher degrees of functional independence on admission. Design: A retrospective study. Setting: A public acute long-term care hospital. Patients: All cardiac rehabilitation patients (N = 143) admitted to the hospital from January 1998 through June 1999. Patients were divided into a higher- and a lower-functioning group by using the admission FIM(TM) instrument scores above and below the midpoint of 72. Comparisons in LOS, discharge disposition, and functional gains between these 2 groups were then performed. Interventions: Not applicable. Main Outcome Measures: FIM scores, FIM change, FIM gains per week, LOS, and discharge disposition. Results: Total FIM scores at discharge were significantly higher than those on admission (25%, P < .0001). The median value of total FIM gains per week was 7.78 with a stay of 17 days and a home discharge rate of 76%. The higher-functioning group (n = 106) differed from the lower group (n = 37) with shorter stay (15 vs 23d, P < .0001), greater FIM gains per week (8.6 vs 4.8, P = .002), and greater likelihood of discharge to home or community (84% vs 54%, P < .001). The average incremental FIM change in each group was the same. In multivariate analysis, both admission (P = .001) and discharge (P < .001) FIM scores were the best predictors of patients' discharge disposition to home. Conclusions: Admission FIM scores are important predictors for the clinical course and discharge outcomes of cardiac rehabilitation patients, with those with higher admission FIM scores having a shorter LOS and greater likelihood of discharge to home. The admission FIM scores can help to establish realistic goals.