The Impact of Chronic Kidney Disease on Rehabilitation Outcomes as Measured by the Functional Independence Measure in the Recovery Unit

Shintaro Iio, Kenjiro Kunieda, Takashi Shigematsu, Ichiro Fujishima, Hiroki Yabe, Aki Tabata
Purpose:

The study aimed to evaluate the relationship between CKD severity and rehabilitation outcomes in non-dialysis-dependent patients admitted to rehabilitation wards. The main objectives were to assess how CKD influences functional independence measure (FIM) gains, FIM efficiency, and length of stay. 

Methods:

This retrospective cohort study included patients admitted to Hamamatsu Rehabilitation Hospital between 2014 and 2023. The following data were collected as measurement items: patient characteristics, blood data, calculated disease classification, and FIM at the time of admission and discharge. For statistical analysis, a one-way analysis of variance and multiple comparison test were performed to compare each group in CKD stages 1-5. Furthermore, patients were divided into two groups: those with renal dysfunction and those without renal dysfunction at CKD stage 3b, and comparisons of patient characteristics were made using an unpaired t-test, while comparisons of FIM gain, FIM effectiveness, and FIM effect were made using a covariance analysis adjusted for age, gender, BMI, blood data, and calculated disease category as confounding factors.

Results:

Out of 13,268 patients, 1,442 had CKD, and 9,390 were non-CKD. CKD patients were older and The proportion of patients with musculoskeletal disorders and disuse syndrome was significantly higher. There was a trend for FIM gain and FIM effectiveness to decrease as the severity of CKD progressed.　 After adjusting for confounding factors, the results of the analysis of covariance were as follows.　CKD gorup had lower FIM gains (14.6 ± 14.4) compared to non-CKD patients (16.9 ± 15.5, p 0.001) and lower FIM effectiveness (0.34 ± 0.35 vs. 0.40 ± 0.39, p 0.001).

Conclusion(s):

CKD negatively impacts rehabilitation outcomes, with patients demonstrating lower FIM gains and effectiveness compared to non-CKD patients. 

Implications:

This study emphasizes the importance for physiotherapists to recognize CKD as a key factor affecting rehabilitation outcomes. Tailored rehabilitation plans are essential to maximize functional improvements in CKD patients, and further research should investigate specific interventions to improve their recovery.

Funding acknowledgements:
There is no funding.
Keywords:
Chronic kidney disease
Renal rehabilitation
Functional independence measure
Primary topic:
Disability and rehabilitation
Second topic:
Health promotion and wellbeing/healthy ageing/physical activity
Third topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Ethical approval was obtained from Seirei Christopher University and Hamamatsu Rehabilitation Hospital Ethics Committees.
Provide the ethics approval number:
23504
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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