Predicting the achievement of 6 grades of physical independence from data routinely collected at admission to rehabilitation.
OBJECTIVE
To develop prognostic indexes with which to establish the likelihood of individuals achieving specific grades of physical independence by the conclusion of inpatient rehabilitation.


METHODS
Logistic regression with prospective validation.


METHODS
Five hundred sixty inpatient rehabilitation facilities.


METHODS
Records of 218,290 adults discharged in 1995 were used to establish the grades and the indexes predicting those grades. There were 259,806 1997 discharges included in the validation.


METHODS
Not applicable.


METHODS
Six physical independence grades reflecting the most likely profiles of performance across the 13 motor FIM items.


RESULTS
After severity adjustment, patients 65 years of age or younger, compared with those 84 years of age or older, had odds ratios of reaching higher grades ranging from 1.5 (95% confidence interval [CI], 1.4-1.7) to 7.5 (95% CI, 4.3-13.1). Admission to rehabilitation within 2 weeks of disability was associated with more favorable prognoses. Areas under the receiver operating characteristic curve ranged from.80 to.94 for the indexes, with minimal shrinkage on prospective validation.


CONCLUSIONS
The models have sufficient reliability to establish from admission information the likelihood that a patient will achieve a specific grade of physical independence by the time of discharge from rehabilitation. The capacity to quantify prognosis has clinical, policy, and research applications.
Stineman
Margaret G
MG
Department of Rehabilitation Medicine, University of Pennsylvania, Philadelphia, 19104-2676, USA.
Ross
Richard N
RN
Granger
Carl V
CV
Maislin
Greg
G
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000145:classification* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome