FUNCTIONAL MEASURES OF FIRST-STROKE REHABILITATION INPATIENTS - USEFULNESS OF THE FUNCTIONAL INDEPENDENCE MEASURE TOTAL SCORE WITH A CLINICAL RATIONALE

Objective: The Functional Independence Measure (FIM) was used to measu re function in first-stroke patients on admission to and discharge fro m a rehabilitation center, and to determine gain; all data were analyz ed by a clinically oriented approach. Design: All patients admitted af ter a first supratentorial stroke to a comprehensive rehabilitation fa cility over a 2-year period were examined prospectively with the FIM. Diagnosis was determined by neuroimaging. Data were collected continuo usly and stored in the departmental database. For analysis of data, th e patients were divided by side of lesion (right or left hemisphere), main clinical syndrome (presence or absence of neglect or aphasic synd romes in those with damage to the right or left hemisphere, respective ly), type of lesion (ischemic, hemorrhagic, etc), and site of lesion ( cortical or subcortical). Setting: Neurological rehabilitation ward. P atients: The study population included 151 patients of average age 60. 8 years; 60% were men. All were admitted an average of 28.9 days after stroke and rehabilitated for 109.3 days. Main Outcome Measure: The ra w FIM total score was determined at 48 to 72 hours after admission and at discharge. FIM gain was calculated by subtracting the FIM discharg e score from the FIM admission score for each individual. Length of st ay was also recorded. Results: There was no difference in average tota l FIM scores when patients were divided by side of damage (right or le ft hemisphere). Significant findings were obtained for the various par ameters when the clinical criterion was applied. Patients with neglect or aphasia syndromes showed significantly higher gains despite their lower FIM admission scores, but they had a much longer in-hospital sta y. Conclusion: The raw FIM total score is a simple, practical, and eff icient measure of function in first-stroke patients on admission for r ehabilitation, provided an appropriate clinical approach is used durin g data analysis. Results can be used for comparison with similar measu res, determination of admission and discharge policy, and program eval uation. The presence of neglect and aphasic syndromes has a significan t effect on the various measures. Length of stay in rehabilitation is also of paramount importance in stroke patients with special clinical syndromes. (C) 1997 by the American Congress of Rehabilitation Medicin e and the American Academy of Physical Medicine and Rehabilitation.