Function In Sitting Test Admission Score Predicts Inpatient Rehabilitation Discharge Destination.

Research Report
Population: Adult

Sharon L. Gorman, PT, DPTSc, GCS, Associate Professor, Samuel Merritt University

Cathy Harro, PT, MS, NCS, Assistant Professor, Grand Valley State University

Keywords: Prevention, Outcome Measures, Sitting balance, Discharge Destination

Purpose/Hypothesis: To determine the relationship between Function In Sitting Test (FIST) and other measures of balance and function in regards to length of stay and discharge destination; as well as to determine if these measures predict discharge destination after inpatient rehabilitation (IPR).

Number of Subjects: 125

Methods/Materials: This was a prospective, nonblinded, reference-standard comparison study of a population-based sample of 125 adults (56% male, average age 60 years, ±16.63) with sitting balance dysfunction from 4 accredited IPR units in the US, excluding persons with spinal cord injury, significant bracing/orthotics, and inability to perform testing safely. FIST, Functional Independence Measure (FIM), and Berg Balance Scale (BBS) measured within first 5 days of IPR admission and within 3 days of discharge served as the primary measures.

Results: Participants were grouped by discharge destination as follows: home, home with assistance, and other discharge location. ANOVA showed significant differences for all outcome measures (FIST, FIM, and BBS) between admission and discharge scores (p < 0.000). FIST admission scores and all measures’ discharge scores differed significantly by discharge group (p < 0.000); whereas FIM and BBS admission scores demonstrated significant differences only between home and home with assist (p < 0.000), and home and other discharge location (p < 0.000). Length of stay in IPR was significantly related to discharge location (p < 0.000), while age (p = .170) and gender (p = .927) demonstrated no relationship. Ordinal multivariate logistic regression could not determine an equation, so the home and home with assistance groups were merged into ultimate home category. Using binary logistic regression, only the FIST admission score was a significant predictor of ultimate home discharge with an odds ratio of 1.13 (p < 0.001). This model correctly predicted ultimate home discharge with 85.8% accuracy (receiver operator characteristic curve goodness-of-fit area under curve = .89, p < 0.000, 95% CI .814-.966). The receiver operator characteristic curve differentiated FIST admission scores of those with ultimate home discharge versus other discharge destinations, with a FIST admission score of 41.5 as the cutoff (sensitivity = .938, 1- specificity = .441, area under the curve = .819, p < 0.000, 95% CI .741-.897).

Conclusions: All outcome measures at admission and discharge significantly differentiated between groups based on discharge destination, demonstrating predictive validity. The FIST demonstrates strong predictive validity; a FIST admission score of less than 42 points indicated patients more likely to be discharged to locations other than home after IPR, regardless of availability of assistance.

Clinical Relevance: FIST admission scores on admission in patients with sitting balance dysfunction can help predict which patients may not achieve a discharge to home after IPR. Early identification of these patients may improve interprofessional discharge planning efforts earlier in the course of IPR.

Gorman, Sharon L., PT, DPTSc, GCS; Harro, Cathy C., PT, MS, NCS. Function In Sitting Test Admission Score Predicts Inpatient Rehabilitation Discharge Destination.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.