Association between the Functional Independence Measure following spinal cord injury and long-term outcomes

Study design: Retrospective cohort. Objectives: To estimate the association between the Functional Independence Measure (FIM) for spinal cord injury (SCI) patients at time of discharge from rehabilitation and long-term resource utilization, residential status and employment. The intention was to assess the value of FIM for projecting economic burden in SCI. Setting: Federally designated spinal cord injury model system facilities throughout the USA. Methods: We analyzed data from the National Spinal Cord Injury Statistical Center database (n = 14 620) (1988-2010), excluding subjects with: age <6 years, normal motor function, death before discharge or etiology from gunshot or penetrating wound (n = 11 685 retained). We investigated the association between motor FIM at rehabilitation discharge and residential status, survival and outcomes at 1, 5, 10, 15 and 20 years follow-up, including FIM, residential status, hospitalizations, days hospitalized in previous year, daily paid and total care and paid hours worked. Regression controlled for injury completeness, neurological level, demographic characteristics and temporal effects. Results: All outcomes were statistically associated with higher FIM scores at discharge. Each one-point increment in FIM was associated with improvements in: probability of institution care at discharge (-0.34%) and at follow-up (-0.13%), FIM score at follow-up (0.76 points), hospitalizations and days hospitalized/year (-0.0044 and -0.071, respectively), probability of needing paid assistance (-0.72%) or any assistance (-0.85%) and probability of paid work (0.41%). Conclusion: The FIM at discharge has predictive value for long-term outcomes. Improvement in FIM suggests reduced economic burden in SCI patients. Sponsorship: Novartis Pharmaceuticals Corporation. Spinal Cord (2012) 50, 728-733; doi:10.1038/sc.2012.50; published online 29 May 2012