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FIM Motor Scores for Classifying Community Discharge After Inpatient Rehabilitation for Hip Fracture
Author(s) -
Wang ChingYi,
Graham James E.,
Karmarkar Amol M.,
Reistetter Timothy A.,
Protas Elizabeth J.,
Ottenbacher Kenneth J.
Publication year - 2014
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2013.12.008
Subject(s) - rehabilitation , functional independence measure , medicine , hip fracture , receiver operating characteristic , physical therapy , discharge planning , physical medicine and rehabilitation , retrospective cohort study , surgery , osteoporosis , nursing , endocrinology
Objective To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. Design Retrospective cohort study. Setting A total of 1257 inpatient rehabilitation facilities in the United States. Patients Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. Methods Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. Main Outcome Measurements Discharge setting (community versus institutional). Results Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. Conclusions Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.