Home > Riviste > European Journal of Physical and Rehabilitation Medicine > Fascicoli precedenti > Europa Medicophysica 1999 December;35(4) > Europa Medicophysica 1999 December;35(4):177-83



Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca





Europa Medicophysica 1999 December;35(4):177-83


lingua: Inglese

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.

inizio pagina