The utility of short-term goal achievement as an early indicator of discharge destination in people admitted to neurological rehabilitation with severe functional deficits.

Abstract

This study investigates whether short-term goal achievement in the early phase of neurological rehabilitation is an accurate indicator of discharge destination in patients with severe disability in comparison to change in scores in the motor domain of the Functional Independence Measure (FIM motor). A prospective observational cohort study. A consecutive sample of 53 patients admitted to rehabilitation with a neurological diagnosis and FIM motor score below 47. Measures: Short-term goal achievement and FIM motor change in the first 2 weeks following admission and discharge destination. Short-term goal achievement showed good prognostic utility [area under the curve (AUC) of 0.75; 95% confidence intervals (CI) 0.6, 0.89] for discharge destination, dichotomized as home or semi-independent living versus nursing home care, similar to that demonstrated by change in FIM motor scores (AUC of 0.69; 95% CI 0.55, 0.84), p = 0.55. A cut-off was established for short-term goal achievement at more than half of goals achieved, with an AUC of 0.73 (95% CI 0.58, 0.87); sensitivity 71.4% and specificity 74.4%. Short-term goal achievement in the early phase post-admission is a good indicator of the person's potential to return home. Implications for Rehabilitation Short-term goal setting should be a key practice feature of neurological rehabilitation. Goal achievement is an indicator of a person's potential to return home or to semi-independent living in people with severe neurological deficits. Evaluation of short-term goal achievement may inform the ongoing rehabilitation program and discharge planning.