Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study

Abstract

Purpose: To examine whether Functional Independence Measure (FIM) scores on admission can predict the future care levels of patients after acute stroke. Methods: In this multicenter retrospective cohort study, we enrolled post-acute stroke patients and assessed stroke subtypes, self-care abilities using FIM scores, and discharge destination. Patients’ care levels were assessed according to the Long-Term Care Insurance (LTCI) system (0–5: slight impairment to bedridden), the national insurance plan for care in Japan, at discharge. We divided patients into two groups according to LTCI care levels (0–2 versus 3–5) to compare their clinical characteristics using multivariate logistic regression analysis. The trial was registered with the UMIN Clinical Trials Registry (UMIN000012653). Results: Of the 1261 patients (47% female, mean age 75 years), 492 (39%) fulfilled LTCI care levels 0–2. FIM scores on admission were significantly correlated with LTCI care levels (p < 0.001). On multivariate analysis, age and FIM scores on admission were found to be independent predictors of LTCI care levels 0–2. Conclusions: FIM scores on admission after stroke can independently predict later care requirements. Early prediction of LTCI care levels may contribute to the early supported discharge and improve the efficiency of healthcare planning.

Implications for Rehabilitation

• There is a clear relationship between Functional Independence Measure (FIM) scores and the care levels certified by the Long-Term Care Insurance (LTCI) system, a national healthcare and insurance system in Japan.

• FIM scores on admission can predict future LTCI care levels required for patients after acute stroke.

• Early prediction of LTCI care levels may contribute to early supported discharge, improve the efficiency of stroke management and assist healthcare planning.

• Functional independence measure
• functional outcome
• long-term care insurance
• patient discharge
• stroke

Acknowledgements

We are grateful to the members of the stroke rehabilitation steering committee, all medical social workers of the hospitals included in this study, and the members of the Rehabilitation Support Center in Himeji Public Health Center (Miyuki Fujii and Yoshifumi Kaneko) for their assistance with data acquisition.

Declaration of interest

The authors declare no conflicts of interests. The authors alone are responsible for the content and writing of this article.