Jain Nitin B, Al-Adawi Samir, Dorvlo Atsu S S, Burke David T
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114, USA.
Am J Phys Med Rehabil. 2008 Jan;87(1):21-5. doi: 10.1097/PHM.0b013e31815e61af.
To assess the association of body mass index (BMI) with functional independence measure (FIM) score in patients with deconditioning. We also examined whether the association was different for motor and cognitive subscales of the FIM instrument.
A retrospective study of 1077 inpatients admitted to the general medicine service for deconditioning at an acute rehabilitation hospital. Patients were classified into underweight (BMI < 18.5), normal range (BMI = 18.5-24.9), overweight (BMI = 25.0-29.9), obese class I (BMI = 30.0-34.9), obese class II (BMI = 35.0-39.9), and obese class III (BMI > or = 40).
Median gain in FIM scores from admission to discharge was highest in obese class I patients (27 points), followed by obese class II patients (26 points). The most gain in FIM scores was accounted for by the motor subscale. Adjusting for age, gender, and length of in-hospital stay, obese class I patients had a 5.8-point (95% confidence limits = 1.2, 7.0) higher gain in FIM score compared with patients with BMI in the normal range.
In an acute rehabilitation setting, obese patients had higher gains in FIM scores as compared with normal-range-BMI patients. Most of the improvements in FIM scores were accounted for by the motor subscale, with little or no improvement on the cognitive scale.
评估身体机能下降患者的体重指数（BMI）与功能独立性测量（FIM）得分之间的关联。我们还研究了FIM工具的运动和认知子量表的这种关联是否存在差异。
对一家急性康复医院普通内科收治的1077例因身体机能下降而住院的患者进行回顾性研究。患者被分为体重过轻（BMI<18.5）、正常范围（BMI = 18.5 - 24.9）、超重（BMI = 25.0 - 29.9）、I级肥胖（BMI = 30.0 - 34.9）、II级肥胖（BMI = 35.0 - 39.9）和III级肥胖（BMI≥40）。
从入院到出院FIM得分的中位数增加在I级肥胖患者中最高（27分），其次是II级肥胖患者（26分）。FIM得分增加最多的是运动子量表。在调整年龄、性别和住院时间后，与BMI在正常范围的患者相比，I级肥胖患者的FIM得分增加了5.8分（95%置信区间 = 1.2, 7.0）。
在急性康复环境中，与BMI在正常范围的患者相比，肥胖患者的FIM得分增加更高。FIM得分的大部分改善是由运动子量表引起的，认知量表几乎没有改善。
