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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 1999 December;35(4):177-83

language: English

A com­par­i­son ­between exten­sive and inten­sive reha­bil­i­ta­tion: FIM meas­ure­ments as indi­ca­tors of appro­pri­ate­ness and effi­cien­cy

Crimaldi S. 1, Porta G. 1, Vaccari A. 1, Springhetti I. 2, Tesio L. 2

1 Institute of Geriatric Rehabilitation, Pio Albergo Trivulzio, Milano, Italy;
2 Rehabilitation Department, Fondazione Salvatore Maugeri, ­IRCCS, Pavia, Italy


BACKGROUND: In Italy, ­post-­acute inpa­tient reha­bil­i­ta­tion is avail­able in ­both “inten­sive” and “exten­sive-ger­i­at­ric” reha­bil­i­ta­tion facil­ities (IF and EF, respec­tive­ly). Three vs 1 ­hour/dai­ly of for­mal reha­bil­i­ta­tion (includ­ing reha­bil­i­ta­tion nurs­ing) ­should be admin­is­tered in ­either set­ting, respec­tive­ly. For any giv­en ­case, no for­mal cri­te­ria of ­patient allo­ca­tion are avail­able.
METHODS: Patients dis­charged ­from ­either a 50-bed IF (n=251, 6-­month ­time ­span) or a 50-bed EF (n=142, 12-­month ­time ­span) locat­ed in north­ern Italy ­were com­pared. The FIM™-Functional Independence Measure Scale and ­data set was adopt­ed. The FIM ­rates ­patients’ inde­pen­dence in the ­domains of ­self-­care, sphinc­ter con­trol, mobil­ity, loco­mo­tion, com­mu­ni­ca­tion and ­social cog­ni­tion. On a 18-­item 7-lev­el ­scale, ­total ­scores may ­range ­from 18 to 126, and are high­er the great­er ­patient’s inde­pen­dence.
RESULTS: The prev­a­lence of neu­ro­log­i­cal impair­ments was 41% and 27% in the IF and EF, respec­tive­ly, of ­either ­unit. Orthopaedic impair­ments ­were 56% and 61%, respec­tive­ly. Mean age was 64 (IF) vs 80 yrs. (EF). Mortality dur­ing the ­stay was 0.8 vs 8% in IF vs, EF, respec­tive­ly. Mean admis­sion and dis­charge ­scores ­were 80 and 106 in the IF, vs 64 and 80 in the EF. Median ­length of ­stay was 32 (IF) vs 85 (EF) ­days. Ninety-one per ­cent of IF ­patients ­were dis­charged ­home, vs 70% of the EF ­patients. A great­er FIM ­score at admis­sion pre­dict­ed a low­er mor­tal­ity.
CONCLUSIONS: The low­er per­for­manc­es of the EF are con­sis­tent ­with the ­patients ­being old­er, ­more clin­i­cal­ly ­unstable, ­more depen­dent at admis­sion, and pre­sum­ably unsuit­able for ­more ­than 1 ­hour dai­ly of reha­bil­i­ta­tion pro­ce­dures. These dif­fer­enc­es in the ­case-mix ­seem to be con­sis­tent ­with the spe­cif­ic mis­sion of ­either facil­ity. In ­either ­type of facil­ity, the FIM™ ­appears to be a val­id ­help for for­mal deci­sions on appro­pri­ate­ness of admis­sion, for the assess­ment of the bur­den of ­care, and for the meas­ure­ment of effec­tive­ness of the treat­ment.

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