Validity of functional independence staging in patients receiving rehabilitation in skilled nursing facilities.

OBJECTIVES

To determine the psychometric performance and clinical applicability of the Functional Independence Staging (FIS) system for activities of daily living (ADLs), sphincter management, mobility, and executive function in patients receiving rehabilitation in the skilled nursing facility (SNF) setting.

DESIGN

A retrospective analysis of secondary data using data from a privately owned administrative dataset. Setting Seventy SNFs under contract with SeniorMetrix Inc health plan clients.

PARTICIPANTS

Patients (N=7526) covered by Medicare+Choice plans and admitted to an SNF in 2002.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Analysis of construct validity, sensitivity to change, and predictive validity.

RESULTS

The FIS score in each domain except mobility at admission was higher for patients with no concomitant disease than for patients classified as moribund ( P <.001). The odds of being discharged to the community were consistently greater for patients with higher discharge FIS scores in sphincter management (odds ratio [OR] range, 1.32-1.76), mobility (OR range, 1.93-4.66), and executive function (OR range, 1.50-4.15). Discharge FIS score was greater than admission FIS score for all domains ( P <.001). The odds of being discharged to the community were fairly consistently predicted by admission FIS score in ADLs (OR range, 1.26-3.73) and executive function (OR range, 1.60-5.05).

CONCLUSIONS

The FIS system has reasonable psychometric properties that suggest it may be applied to the assessment and monitoring of functional status in patients admitted for rehabilitation in SNF settings. The system may be useful for determining the type of therapy that might be required or to predict the likely discharge needs of the patient.