Measuring patient-reported outcomes after discharge from inpatient rehabilitation settings

Objective: To examine the sensitivity of the Short Form Activity Measure for Post-Acute Care ( AM-PAC) in comparison to the Functional Independence Measure ( FIM (TM)) across a 12-month period after discharge from rehabilitation hospital. Design: Prospective longitudinal study. Patients were recruited while receiving inpatient services from facilities in the north-east USA and interviewed 1, 6 and 12 months thereafter. Patients: Convenience sample of 516 patients at baseline ( 65% retention at the final follow-up) receiving rehabilitation services for neurological, lower extremity orthopedic, or complex medical conditions. Mean age 68.3 years; 47% male. Main outcome measures: AM-PAC Physical and Movement, Personal Care and Instrumental, and Applied Cognitive Activity scales; FIM (TM) Motor and Cognitive scales. Results: All 3 AM-PAC scales were sensitive to both positive and negative change across the follow-up period. Standardized response means for the AM-PAC were consistently larger than for the FIM (TM) across patient and severity groups. A greater percentage of patients showed positive change that exceeded the minimal detectable change on the AM-PAC than on the FIM (TM) at both 6- and 12-month follow-ups. Conclusion: The short-form AM-PAC scales are more sensitive measures of change in functional activity performance over time in the general population of persons who receive inpatient rehabilitation services compared to the FIM (TM). Thus, the AM-PAC offers a short, comprehensive, and sensitive measure of positive and/or negative change in patients' ability to perform important activities of daily life.