Chiou-Tan Faye Y, Keng Moses J, Graves Daniel E, Chan Kwai-Tung, Rintala Diana H
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and the Center for Trauma Rehabilitation Research, Harris County Hospital District, Houston, Texas 77004, USA.
Am J Phys Med Rehabil. 2006 May;85(5):415-23. doi: 10.1097/01.phm.0000214320.99729.f3.
To explore racial/ethnic differences in FIM data from admission to discharge in underinsured patients undergoing inpatient stroke rehabilitation.
This is a retrospective analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database of an inpatient rehabilitation unit of a county hospital in a large urban city. Data included 171 adult patients admitted to the stroke rehabilitation unit between January 2000 and October 2003. Main outcome measures included admission and discharge total FIM score, FIM gain, FIM efficiency, and length of stay (LOS). Data were analyzed using chi analyses, t tests, univariate analysis of variance, binary logistic regression, and hierarchical multiple regression.
Data from 68 Hispanic, 83 black, and 20 white patients were included in the study. Univariate tests revealed that race/ethnicity groups differed significantly on admission FIM score (F=5.38, P<0.005), FIM gain (F=4.35, P<0.014), and FIM efficiency (F=3.42, P<0.035). Post hoc pairwise comparisons revealed that Hispanics had lower admission FIM scores than blacks (58.9 vs. 68.9). However, Hispanics had higher FIM gain scores than blacks (26.8 vs. 21.5). Race/ethnicity was not significantly related to age, gender, side of stroke, type of stroke, time from onset of stroke to rehabilitation admission, discharge FIM score, or LOS. Multiple regression analyses revealed that after controlling for all other available factors, race/ethnicity accounted for a significant amount of additional variance in admission FIM score (5.8%) and FIM efficiency (4.6%), but not in discharge FIM score, FIM gain, or LOS. Race/ethnicity was not predictive of discharge disposition.
Differences in functional independence at admission to poststroke rehabilitation and the average daily improvement in function are related, in part, to patients' race/ethnicity. Differences in change in functional independence from admission to discharge (FIM gain) are not related to race/ethnicity once other factors, particularly admission FIM score, are taken into account. Future studies should identify reasons why Hispanics have lower admission FIM scores because demographic and stroke-related variables were not related to ethnicity yet have outcomes similar to blacks and whites at discharge.
探讨未参保住院脑卒中康复患者从入院到出院时功能独立性测量（FIM）数据中的种族/民族差异。
这是一项对大城市一家县医院住院康复科的医学康复统一数据系统（UDSMR）数据库的回顾性分析。数据包括2000年1月至2003年10月期间入住脑卒中康复科的171例成年患者。主要结局指标包括入院和出院时的FIM总分、FIM得分提高值、FIM效率及住院时间（LOS）。采用卡方分析、t检验、单因素方差分析、二元逻辑回归和分层多元回归对数据进行分析。
研究纳入了68名西班牙裔、83名黑人及20名白人患者的数据。单因素检验显示，种族/民族组在入院时的FIM得分（F = 5.38，P < 0.005）、FIM得分提高值（F = 4.35，P < 0.014）和FIM效率（F = 3.42，P < 0.035）方面存在显著差异。事后两两比较显示，西班牙裔患者入院时的FIM得分低于黑人（58.9对68.9）。然而，西班牙裔患者的FIM得分提高值高于黑人（26.8对21.5）。种族/民族与年龄、性别、脑卒中部位、脑卒中类型及从脑卒中发作到康复入院的时间、出院时的FIM得分或住院时间均无显著相关性。多元回归分析显示，在控制了所有其他可用因素后，种族/民族在入院时的FIM得分（5.8%）和FIM效率（4.6%）方面解释了显著的额外方差，但在出院时的FIM得分、FIM得分提高值或住院时间方面则不然。种族/民族不能预测出院结局。
脑卒中康复入院时的功能独立性差异及功能的平均每日改善情况部分与患者的种族/民族有关。一旦考虑了其他因素，尤其是入院时的FIM得分，从入院到出院的功能独立性变化（FIM得分提高值）差异与种族/民族无关。未来的研究应确定西班牙裔患者入院时FIM得分较低的原因，因为人口统计学和脑卒中相关变量与种族无关，但出院时的结局与黑人和白人相似。
