title: The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: a prospective cohort study.
abstract: OBJECTIVE
  Long-term acute care hospitals (LTACHs) have emerged for patients requiring medical care beyond a short stay. Minimal data have been reported on functional outcomes in this setting. The purposes of this study were: (1) to measure the clinical utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) in an LTACH setting and (2) to explore the association between FSS-ICU score and discharge setting.
  
  
  METHODS
  Data were obtained from 101 patients (median age=70 years, interquartile range [IQR]=61-78; 39% female, 61% male) who were admitted to an LTACH. Participants were categorized into 1 of 5 groups by discharge setting: (1) home (n=14), (2) inpatient rehabilitation facility (n=26), (3) skilled nursing facility (n=23), (4) long-term care/hospice/expired (n=13), or (5) transferred to a short-stay hospital (n=25).
  
  
  METHODS
  Data were prospectively collected from a 38-bed LTACH in the United States over 8 months beginning in September 2010. Functional status was scored using the FSS-ICU within 4 days of admission and every 2 weeks until discharge. The FSS-ICU consists of 5 categories: rolling, supine-to-sit transfers, unsupported sitting, sit-to-stand transfers, and ambulation. Each category was rated from 0 to 7, with a maximum cumulative FSS-ICU score of 35.
  
  
  RESULTS
  Cumulative FSS-ICU scores significantly improved from a median (IQR) of 9 (3-17) to 14 (5-24) at discharge. Median (IQR) cumulative discharge FSS-ICU scores were significantly different among the discharge categories: home=28 (22-32), inpatient rehabilitation facility=21 (15-24), skilled nursing facility=14 (8-21), long-term care/hospice/expired=5 (0-11), and transfer to a short-stay hospital=4 (0-7).
  
  
  CONCLUSIONS
  Patients receiving therapy at an LTACH demonstrate significant improvements from admission to discharge using the FSS-ICU. This outcome tool discriminates among discharge settings and successfully documents functional improvements of patients in an LTACH setting.
authors.affiliation: Good Shepherd Penn Partners, 1800 Lombard St, Philadelphia, PA 19146, USA. aaron.thrush@uphs.upenn.edu
authors.forename: Aaron
authors.initials: A
authors.lastname: Thrush
authors.forename: Melanie
authors.initials: M
authors.lastname: Rozek
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dekerlegand
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010414:Pennsylvania / Q000453:epidemiology; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy; D012866:Skilled Nursing Facilities