Influence of Length of Stay on Functional Independence Measures in Stroke Inpatients

Introduction: Stroke is one of the leading causes of death worldwide. Initiating rehabilitation in the early phase is paramount to preventing further disability and impairment. Greater impairments result in longer length of stay; however, this can be extremely costly for both providers and patients. Functional Independence Measure (FIM) is a tool used to assess the degree of disability for patients admitted to an Inpatient Rehabilitation Facility. The functional independence measures usually provide guidance in planning rehabilitation care. Ensuring efficiency in rehabilitation requires collaborative multidisciplinary effort to ensure rehabilitation is effective and functional outcomes are met. Rehabilitation post stroke is a restorative process aimed at ensuring the patient achieves maximum functional outcomes. Objectives: This study aimed to determine if the Length of Stay (LoS) for patients would affect the Functional Independence Measure (FIM) of stroke patients in the Inpatient Rehabilitation Facility (IRF). Material and methods: A retrospective chart review of patients admitted as inpatient for post-stroke management from 2018 to 2021. The analysis encompassed demographic and stroke-related variables, including type, severity, and location of the stroke. Continuous variables (length of stay, demographics) were run using Anova. Multiple linear regressions were run using FIM on admission, discharge, gain and efficiency as dependent variables against four LoS groups (90 days). Regressions tests involved the use of three different models. Model 1 was not adjusted, whereas model 2 was adjusted to account for age and gender. Model 3 was adjusted to account for age, gender, stroke type, stroke severity, and stroke site/location. Results: Regression model with length of stay and functional independence measures on discharge was found to be statistically significant in the reference group (LoS < 30 days) with a 23.7-point increase in model 2 (adjusted for age and gender). The LoS > 91-day group proved to be the least efficient across all three groups when compared to the reference group (