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Methods for Comparing Functional Independence Measure Improvement Degree for Stroke Patients between Rehabilitation Hospitals

Makoto Tokunaga, Shuji Mita, Keiichi Tashiro, Makio Yamaga, Yoichiro Hashimoto, Rhoji Nakanishi and Hiroaki Yamanaga

When assessing the extent of improvement in Functional Independence Measure (FIM) scores for stroke patients between rehabilitation hospitals-such as Japan's Kaifukuki Rehabilitation Wards—one must note with caution that ceiling effects are present in FIM gain, defined as FIM at discharge minus FIM at admission. In cases where significant differences are present in FIM scores at admission, a variety of techniques may be used, including stratification by FIM scores at admission, FIM effectiveness, and multiple linear regression analysis. Alternative indicators of FIM improvement, which are less sensitive to FIM scores at admission than FIM effectiveness, include corrected FIM effectiveness and the deviation value of FIM gain. When comparing the FIM improvement degree among different hospitals, these methods are augmented by additional techniques, including limiting patients based on FIM scores at admission, case-control study matching FIM scores at admission, and adjustment of FIM gain by standard severity distribution. When comparing FIM improvement degree between hospitals, it is necessary to understand the advantages and disadvantages of these eight methods and analyze it taking into account the difference in patients' severity.