A comparison between extensive and intensive rehabilitation: FIM measurements as indicators of appropriateness and efficiency

Background: In Italy, post-acute inpatient rehabilitation is available in both 'intensive' and 'extensive-geriatric' rehabilitation facilities (IF and EF, respectively). Three vs 1 hour/daily of formal rehabilitation (including rehabilitation nursing) should be administered in either setting, respectively. For any given case, no formal criteria of patient allocation are available. Methods. Patients discharged from either a 50-bed IF (n=251, 6-month time span) or a 50-bed EF (n=142, 12-month time span) located in northern Italy were compared. The FIM(TM)-Functional Independence Measure Scale and data set was adopted. The FIM rates patients' independence in the domains of self-care, sphincter control, mobility, locomotion, communication and social cognition. On a 18-item 7-level scale, total scores may range from 18 to 126, and are higher the greater patient's independence. Results. The prevalence of neurological impairments was 41% and 27% in the IF and EF, respectively, of either unit. Orthopaedic impairments were 56% and 61%, respectively. Mean age was 64 (IF) vs 80 yrs. (EF). Mortality during stay was 0.8 vs 8% in IF vs, EF, respectively. Mean admission and discharge scores were 80 and 106 in the IF, vs 64 and 80 in the EF. Median length of stay was 32 (IF) vs 85 (EF) days. Ninety-one per cent of IF patients were discharged home, vs 70% of the EF patients. A greater FIM score at admission predicted a lower mortality. Conclusions. The lower performances of the EF are consistent with the patients being older, more clinically unstable, more dependent at admission, and presumably unsuitable for more than 1 hour daily of rehabilitation procedures. These differences in the case-mix seem to be consistent with the specific mission of either facility. In either type of facility, the FIM(TM) appears to be a valid help for formal decisions on appropriateness of admission, for the assessment of the burden of care, and for the measurement of effectiveness of the treatment.