Stineman M G, Hamilton B B, Goin J E, Granger C V, Fiedler R C
Department of Rehabilitation Medicine, University of Pennsylvania, Philadelphia, PA 19104-2676.
Am J Phys Med Rehabil. 1996 Jan-Feb;75(1):68-78. doi: 10.1097/00002060-199601000-00018.
This study evaluates the relationship of functional severity to patterns of functional gain and length of stay (LOS) for patients discharged from medical rehabilitation. It further compares differences in patterns between summed and Rasch transformed subscales of the Functional Independence Measure (FIM). Two different schemes of the FIM-Function Related Groups (FIM-FRGs) are used to define groups of patients who present with similar degrees of functional severity. The first scheme was developed using summed admission motor and cognitive FIM subscores (FIM-FRGs). The second scheme was developed by transforming these same motor and cognitive FIM subscores into logits (Logit FIM-FRGs), thus making FIM scores more equal-interval. The study included 32,494 patients who were discharged from 123 facilities that submitted data to the Uniform Data System for Medical Rehabilitation (UDSMR) and involved the separate evaluation of 18 different rehabilitation impairment categories. Motor FIM gain was calculated for each FRG in both schemes as the patient's discharge motor FIM score minus the admission motor FIM score. There were four patterns of motor FIM gain and two patterns of LOS across rehabilitation impairment. The most common pattern in both schemes was linear trend, for which median gains and LOS were highest for patients in the most disabled FRGs and lowest for patients in the least disabled FRGs. Gain patterns differed across impairment and across the two schemes. The motor FIM gain distributions provide clinicians with a range of typical functional outcomes for patients admitted to medical rehabilitation. This descriptive approach provides clinicians and administrators with a simple way to compare the motor FIM gain and LOS patterns of patients teated in local facilities with broad-based norms. This sample includes about one-quarter of rehabilitation facilities nationwide, thus representing population standards for facilities participating in the UDSMR. Suggestions are made on how to use these norms most appropriately for both facility and patient comparison.
本研究评估了医疗康复出院患者功能严重程度与功能改善模式及住院时间（LOS）之间的关系。它进一步比较了功能独立性测量（FIM）总分量表和Rasch转换子量表之间模式的差异。两种不同的FIM-功能相关组（FIM-FRGs）方案用于定义功能严重程度相似的患者组。第一种方案是使用入院时运动和认知FIM子量表总分（FIM-FRGs）制定的。第二种方案是通过将相同的运动和认知FIM子量表分数转换为对数单位（Logit FIM-FRGs）来制定的，从而使FIM分数更具等距性。该研究纳入了123个向医疗康复统一数据系统（UDSMR）提交数据的机构出院的32494名患者，并对18种不同康复损伤类别进行了单独评估。在两种方案中均计算了每个FRG组患者运动FIM改善情况，即患者出院时运动FIM分数减去入院时运动FIM分数。在康复损伤方面，运动FIM改善有四种模式，住院时间有两种模式。两种方案中最常见的模式是线性趋势模式，在该模式下，功能最严重FRG组患者的改善中位数和住院时间最长，功能最不严重FRG组患者的改善中位数和住院时间最短。不同损伤类别以及两种方案之间的改善模式有所不同。运动FIM改善分布为医疗康复入院患者提供了一系列典型的功能结局。这种描述性方法为临床医生和管理人员提供了一种简单的方法，可将当地机构治疗患者的运动FIM改善和住院时间模式与广泛的规范进行比较。该样本包括全国约四分之一的康复机构，因此代表了参与UDSMR的机构的人群标准。文中还就如何最恰当地使用这些规范进行机构和患者比较提出了建议。
