Same But Different

FIM Summary Scores May Mask Variability in Physical Functioning Profiles

Steven Fisher, Addie Middleton, James E. Graham, Kenneth Ottenbacher

Research output: Contribution to journalArticle

Abstract

Objective: To examine how similar summary scores of physical functioning using the FIM can represent different patient clinical profiles. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facilities. Participants: Medicare fee-for-service beneficiaries (N=765,441) discharged from inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: We used patients’ scores on items of the FIM to quantify their level of independence on both self-care and mobility domains. We then identified patients as requiring “no physical assistance” at discharge from inpatient rehabilitation by using a rule and score–based approach. Results: In those patients with FIM self-care and mobility summary scores suggesting no physical assistance needed, we found that physical assistance was in fact needed frequently in bathroom-related activities (eg, continence, toilet and tub transfers, hygiene, clothes management) and with stairs. It was not uncommon for actual performance to be lower than what may be suggested by a summary score of those domains. Conclusions: Further research is needed to create clinically meaningful descriptions of summary scores from combined performances on individual items of physical functioning.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StateAccepted/In press - Jan 1 2018

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Masks
Inpatients
Rehabilitation
Self Care
Toilet Facilities
Fee-for-Service Plans
Clothing
Medicare
Hygiene
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Research

Keywords

  • Geriatrics
  • Medicare
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

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abstract = "Objective: To examine how similar summary scores of physical functioning using the FIM can represent different patient clinical profiles. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facilities. Participants: Medicare fee-for-service beneficiaries (N=765,441) discharged from inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: We used patients’ scores on items of the FIM to quantify their level of independence on both self-care and mobility domains. We then identified patients as requiring “no physical assistance” at discharge from inpatient rehabilitation by using a rule and score–based approach. Results: In those patients with FIM self-care and mobility summary scores suggesting no physical assistance needed, we found that physical assistance was in fact needed frequently in bathroom-related activities (eg, continence, toilet and tub transfers, hygiene, clothes management) and with stairs. It was not uncommon for actual performance to be lower than what may be suggested by a summary score of those domains. Conclusions: Further research is needed to create clinically meaningful descriptions of summary scores from combined performances on individual items of physical functioning.",
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N2 - Objective: To examine how similar summary scores of physical functioning using the FIM can represent different patient clinical profiles. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facilities. Participants: Medicare fee-for-service beneficiaries (N=765,441) discharged from inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: We used patients’ scores on items of the FIM to quantify their level of independence on both self-care and mobility domains. We then identified patients as requiring “no physical assistance” at discharge from inpatient rehabilitation by using a rule and score–based approach. Results: In those patients with FIM self-care and mobility summary scores suggesting no physical assistance needed, we found that physical assistance was in fact needed frequently in bathroom-related activities (eg, continence, toilet and tub transfers, hygiene, clothes management) and with stairs. It was not uncommon for actual performance to be lower than what may be suggested by a summary score of those domains. Conclusions: Further research is needed to create clinically meaningful descriptions of summary scores from combined performances on individual items of physical functioning.

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