Association between the functional independence measure following spinal cord injury and long-term outcomes.
METHODS
Retrospective cohort.


OBJECTIVE
To estimate the association between the Functional Independence Measure (FIM) for spinal cord injury (SCI) patients at time of discharge from rehabilitation and long-term resource utilization, residential status and employment. The intention was to assess the value of FIM for projecting economic burden in SCI.


METHODS
Federally designated spinal cord injury model system facilities throughout the USA.


METHODS
We analyzed data from the National Spinal Cord Injury Statistical Center database (n = 14 620) (1988-2010), excluding subjects with: age < 6 years, normal motor function, death before discharge or etiology from gunshot or penetrating wound (n = 11685 retained). We investigated the association between motor FIM at rehabilitation discharge and residential status, survival and outcomes at 1, 5, 10, 15 and 20 years follow-up, including FIM, residential status, hospitalizations, days hospitalized in previous year, daily paid and total care and paid hours worked. Regression controlled for injury completeness, neurological level, demographic characteristics and temporal effects.


RESULTS
All outcomes were statistically associated with higher FIM scores at discharge. Each one-point increment in FIM was associated with improvements in: probability of institution care at discharge (-0.34%) and at follow-up (-0.13%), FIM score at follow-up (0.76 points), hospitalizations and days hospitalized/year (-0.0044 and -0.071, respectively), probability of needing paid assistance (-0.72%) or any assistance (-0.85%) and probability of paid work (0.41%).


CONCLUSIONS
The FIM at discharge has predictive value for long-term outcomes. Improvement in FIM suggests reduced economic burden in SCI patients.


BACKGROUND
Novartis Pharmaceuticals Corporation.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA. jcohen@TuftsMedicalCenter.org
J T
JT
Cohen
R J
RJ
Marino
P
P
Sacco
N
N
Terrin
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult