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To the Editor: We were surprised by the results and conclusions of the study on inpatient rehabilitation and follow-up by Dr Ottenbacher and colleagues¹ and are concerned that they may be in error due to use of Functional Independence Measure (FIM) efficiency as an outcome measure. The finding that FIM efficiency (defined as the change in functional status from admission to discharge divided by the length of stay [LOS]) increased over time as LOS decreased is not unexpected. Given that after a certain point the rate of functional status improvement decreases with length of stay, FIM efficiency must bear an inverse relationship to LOS, all other factors remaining equal. For this reason, a better measure is necessary in order to draw conclusions.

We are also concerned about the changes in sampling over time. It is not stated whether the same 744 facilities reported over the entire period from 1994 . . . [Full Text of this Article]

Pamela W. Duncan, PhD
pwduncan@phhp.ufl.edu

Gerben DeJong, PhD
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions
University of Florida
Gainesville

Helen Hoenig, MD, MPH
Physical Medicine & Rehabilitation Service
Veterans Affairs Medical Center
Durham, NC

Bruce Vogel, PhD
Department of Epidemiology and Health Policy Research
University of Florida

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