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Racial/Ethnic Differences in FIM™ Scores and Length of Stay for Underinsured Patients Undergoing Stroke Inpatient Rehabilitation

Chiou-Tan, Faye Y. MD; Keng, Moses J. Jr. MD; Graves, Daniel E. PhD; Chan, Kwai-Tung MD; Rintala, Diana H. PhD

American Journal of Physical Medicine & Rehabilitation: May 2006 - Volume 85 - Issue 5 - p 415-423
doi: 10.1097/01.phm.0000214320.99729.f3
Research Article: Outcomes
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Chiou-Tan F, Keng MJ Jr, Graves DE, Chan K-T, Rintala DH: Racial/ethnic differences in FIM™ scores and length of stay for underinsured patients undergoing stroke inpatient rehabilitation. Am J Phys Med Rehabil 2006;85:415–423.

Objective: To explore racial/ethnic differences in FIM™ data from admission to discharge in underinsured patients undergoing inpatient stroke rehabilitation.

Design: This is a retrospective analysis of the Uniform Data System for Medical Rehabilitation (UDSMR®) database of an inpatient rehabilitation unit of a county hospital in a large urban city. Data included 171 adult patients admitted to the stroke rehabilitation unit between January 2000 and October 2003. Main outcome measures included admission and discharge total FIM™ score, FIM™ gain, FIM™ efficiency, and length of stay (LOS). Data were analyzed using χ2 analyses, t tests, univariate analysis of variance, binary logistic regression, and hierarchical multiple regression.

Results: Data from 68 Hispanic, 83 black, and 20 white patients were included in the study. Univariate tests revealed that race/ethnicity groups differed significantly on admission FIM™ score (F = 5.38, P < 0.005), FIM™ gain (F = 4.35, P < 0.014), and FIM™ efficiency (F = 3.42, P < 0.035). Post hoc pairwise comparisons revealed that Hispanics had lower admission FIM™ scores than blacks (58.9 vs. 68.9). However, Hispanics had higher FIM™ gain scores than blacks (26.8 vs. 21.5). Race/ethnicity was not significantly related to age, gender, side of stroke, type of stroke, time from onset of stroke to rehabilitation admission, discharge FIM™ score, or LOS. Multiple regression analyses revealed that after controlling for all other available factors, race/ethnicity accounted for a significant amount of additional variance in admission FIM™ score (5.8%) and FIM™ efficiency (4.6%), but not in discharge FIM™ score, FIM™ gain, or LOS. Race/ethnicity was not predictive of discharge disposition.

Conclusions: Differences in functional independence at admission to poststroke rehabilitation and the average daily improvement in function are related, in part, to patients' race/ethnicity. Differences in change in functional independence from admission to discharge (FIM™ gain) are not related to race/ethnicity once other factors, particularly admission FIM™ score, are taken into account. Future studies should identify reasons why Hispanics have lower admission FIM™ scores because demographic and stroke-related variables were not related to ethnicity yet have outcomes similar to blacks and whites at discharge.

From the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (FYC-T, MJK, DEG, K-TC, DHR); the Center for Trauma Rehabilitation Research, Harris County Hospital District, Houston, Texas (FYC-T, K-TC); The Institute for Rehabilitation Research, Houston, Texas (DEG); and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (DHR).

All correspondence and requests for reprints should be addressed to Faye Chiou-Tan, MD, Department of Physical Medicine and Rehabilitation, Quentin Mease Hospital–Harris County Hospital District, Suite 240, 3601 North MacGregor Way, Houston, TX 77004.

Presented, in part, at the American Association for Physiatrists, Tucson, Arizona, 2005.

FIM and UDSMR are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

© 2006 Lippincott Williams & Wilkins, Inc.