Functional screening of lower-limb amputees: a role in predicting rehabilitation outcome?

The Functional Independence Measure (FIM), a single-score instrument used to measure independent functioning in six areas of basic self-care skills, was used to evaluate 68 patients following lower-limb amputation. Patients in a rehabilitation hospital were assessed with the FIM upon admission and discharge. Admission scores averaged 52.7, ranging from 25.2 to 70.0. Patients scoring in the lowest and highest quartiles were compared: no remarkable gender, ethnic, or age differences were evident. Persons with the lowest scores (ie, lowest functioning) had a higher prevalence of hypertension, coronary artery disease, and noninsulin-dependent diabetes mellitus. The success of rehabilitation in patients in the lower two quartiles upon admission was variable and not predicted well by the FIM. In contrast, predictability of rehabilitation success was high in patients functioning higher at admission, the majority achieving near-perfect scores by discharge. Length of hospitalization appeared to be largely unrelated to the net difference in FIM scores over the course of hospitalization.