Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 6
Disclosures: Craig A. Rovito, MD: Nothing to disclose
Objective: Compare domain-specific functional improvement of left middle cerebral artery (MCA) and right MCA strokes by examining FIM efficiency and FIM gain among the 6 FIM sub-scales (self care, sphincter control, transfers, locomotion, communication, and social cognition). Foster development of individualized rehabilitation programs focused on areas of greatest need depending on diagnosis.
Design: Retrospective cohort
Setting: Inpatient rehabilitation facilities, Uniform Data System for Medical Rehabilitation (UDS) data, 2015-2017.
Participants: 38,812 subjects, 20,078 left MCA and 18,734 right MCA ischemic strokes.
Main Outcome Measures: A descriptive study examining differences in the 6 components of FIM between left and right MCA strokes based on admission FIM. Mean FIM efficiency and gain were compared between left and right MCA stroke groups in total, and between two groups based on admission FIM severity categories (<40, 40-80, >80). Secondary outcomes were percentage discharged home and length of stay (LOS).
Results: Total FIM efficiency was higher for left MCA (2.317, 95% CI 2.29-2.34) vs right MCA (2.097, 2.07-2.12), P<.0001. The largest subgroup was admission FIM of 40-80, with 58.76% of patients. FIM gain for this group was higher in left MCA (29.831, 29.61-30.06) vs right MCA (27.900, 27.67-28.12), P<.0001. Left MCAs with admission FIMs <40 and 40-80 had higher FIM efficiencies within FIM subcategories of transfers (P<.0001), self care (P<.0001), locomotion (P<.0001) than right MCA. No difference existed between left and right MCA strokes with admission FIMs>80. Percentage discharged home between left and right MCA was 33.32% and 30.90%, respectively (P<.0001). Left MCA and right MCA with FIM admissions 40-80 had ~2 day difference LOS, P<.0001.
Conclusions: Left MCAs had improved LOS, FIM efficiencies and gains, fitting the paradigm that hemispatial neglect present in right MCA strokes plays an integral role in rehabilitation. These results allow clinicians to rely on data to counsel patients when discussing functional gains based on acute inpatient rehabilitation diagnosis.
Level of Evidence: Level II
To cite this abstract in AMA style:Rovito CA, Park A, Shih S, Goldstein R, Black-Schaffer R, Schneider JC. Improvements in Components of the FIM Instrument: Comparing Left MCA vs Right MCA Ischemic Strokes in Acute Inpatient Rehabilitation [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/improvements-in-components-of-the-fim-instrument-comparing-left-mca-vs-right-mca-ischemic-strokes-in-acute-inpatient-rehabilitation/. Accessed October 23, 2021.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/improvements-in-components-of-the-fim-instrument-comparing-left-mca-vs-right-mca-ischemic-strokes-in-acute-inpatient-rehabilitation/