ORIGINAL ARTICLES   Free access

European Journal of Physical and Rehabilitation Medicine 2015 December;51(6):781-92

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Motor and cognitive function analysis for home discharge using the Functional Independence Measure in patients undergoing cardiac rehabilitation at a long-term acute-care hospital

Sasanuma N. ¹, Takahashi K. ^{2, 3}, Itani Y. ¹, Tanaka T. ¹, Yamauchi S. ¹, Mabuchi S. ¹, Kodama N. ⁴, Ishihara M. ³, Masuyama T. ⁵, Miyamoto Y. ⁶, Domen K. ⁴ ✉

¹ Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan; ² Medical Education Center, Hyogo College of Medicine, Nishinomiya, Japan; ³ Department of Internal Medicine, Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan; ⁴ Division of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan; ⁵ Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan; ⁶ Division of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan

BACKGROUND: Although numerous studies on Functional Independence Measure (FIM) analysis in stroke, orthopedic disease, and spinal cord injury patients have been conducted, it has rarely been done in patients undergoing cardiac rehabilitation (CR).
AIM: To verify whether the Functional Independence Measure (FIMTM) score, and its subscale motor FIMTM and cognitive FIMTM, during inpatient CR can be a predictor of a patient’s readiness for home discharge by establishing an FIMTM cutoff value.
DESIGN: A retrospective, observational cohort study
SETTING: This study was conducted at a long-term acute-care hospital.
POPULATION: Participants were in-hospital patients undergoing CR (N.=949).
METHODS: Measurements included motor FIMTM, cognitive FIMTM, CR period, FIMTM gain per week, and discharge disposition. The strongest predictor for home discharge was analyzed by using multiple logistic regression analysis, and the cutoff value of the FIMTM score for home discharge was determined by using receiver operating characteristic (ROC) curves.
RESULTS: Discharge to home was possible in 723 patients (76.2%), whereas 226 patients (23.8%) had other outcomes. In univariate analysis, a motor FIMTM gain per week of five points was achieved in the home discharge group. Multiple logistic regression analysis revealed that Body Mass Index, number of comorbidities, motor FIMTM at discharge, cognitive FIMTM gain, and CR period were predictive factors with 89.6% predictive ability. ROC curve analysis showed that the cutoff value was a discharge motor FIMTM score of 63/64 points with 0.912 areas under the curve.
CONCLUSION: Discharge motor FIMTM and cognitive FIMTM gain were predictive factors for home discharge. A motor FIMTM gain per week of five points and discharge motor FIMTM score of 64 points at the end of inpatient CR may be important predictors of a patient’s readiness for discharge to home.
CLINICAL REHABILITATION IMPACT: The findings of this study indicate an alternative goal to the activities of daily living in inpatients with cardiovascular disease.