Background and Purpose: Comprehensive components of discharge planning have not been reported in the literature. The Functional Independence Measure (FIM) is often utilized as a functional outcome measure in the inpatient rehabilitation setting that can be utilized for discharge planning. The purpose of this case report is to describe limitations of the FIM and to identify functional measures that augmented the FIM for discharge planning for a patient status post right TKA.
Case description: This patient was a 47-year-old African-American male who was admitted to the inpatient rehabilitation hospital after undergoing a right TKA. He had many comorbidities and health complications which increased his length of stay in the rehabilitation hospital, and the hospital where he had undergone TKA.
Discussion: Gait distance, stair negotiation, and physical assistance needed for these tasks were outcomes measured by the FIM that were able to indicate that the patient could function safely at home. However, variables as described above such as gait speed, distance ambulated before needing a rest break, use of assistive devices/hand rails for stair negotiation, all represent safety considerations that aren’t represented by the FIM for safe community mobility. He also may have been at risk for falls as measured by the 5 Times Sit to Stand Test, and could potentially have challenges with hemodynamic stability during prolonged standing tasks as required for multiple ADLs, all of which were not represented by the FIM. It may be beneficial to utilize other functional outcome measures to augment the FIM to formulate robust discharge considerations.