The FIM instrument in the United States and Italy: a comparative study.
OBJECTIVE
To compare FIM instrument ratings between Italy and the United States.


METHODS
This study utilized 169,835 United States and 4,536 Italian FIM instrument records for stroke with the left side of the body affected, stroke with the right side of the body affected, and orthopedic conditions.


RESULTS
Case-mix, patient age, and admission and discharge FIM instrument scores were similar. The delays between onset of disability and admission to rehabilitation and lengths of stay in rehabilitation were 2-4 times longer in Italy. In Italy, some 88-95% of the subjects were discharged to the community vs. 74-88% in the United States. Hierarchies of FIM instrument ratings across the motor and cognitive items were similar, but there were interesting differences. The hierarchical patterns showed that dressing, bathing, perineal hygiene, and tub or shower transfer were relatively more difficult in Italy compared with the Unites States, whereas walking was easier in Italy compared to the United States.


CONCLUSIONS
The Italian health care payment system offers less incentive for early discharges from acute care and rehabilitation. In Italy, nursing homes are less accessible, whereas family support is more available. Apparently less intensive treatment is applied in Italy, where a minimum time per day for rehabilitation services is not mandatory for payment. Occupational therapy is not used in Italy and the focus is more on physical therapy.
Tesio
Luigi
L
Salvatore Maugeri Foundation, IRCCS, Department of Rehabilitation and the Unit of Research, Functional Assessment and Quality Assurance in Rehabilitation, Pavia, Italy.
Granger
Carl V
CV
Perucca
Laura
L
Franchignoni
Franco P
FP
Battaglia
Mario A
MA
Russell
Carol F
CF
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000503:physiopathology* / Q000534:rehabilitation*; D003431:Cross-Cultural Comparison; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D014481:United States