Combined Effects of Physical Function and Overall Condition on Functional Independence Measure Gains in Rehabilitation Ward Patients During the Recovery Phase

Sep 30, 2026

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In Japan’s aging society, rehabilitation planning increasingly depends on identifying markers that best predict functional recovery. This retrospective study examined 31 convalescent ward inpatients with cerebrovascular or musculoskeletal diseases to determine which combinations of systemic condition biomarkers and physical function measures most strongly forecast Functional Independence Measure (FIM) gains. Systemic status used 14 blood biomarkers, while physical function assessed balance, muscle strength, and walking. Random forest models with five-fold cross-validation ranked predictors, showing composite features such as balance ability plus MCHC.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

Background and objective

Methods

Results

Conclusions

Introduction

How to cite this article

Review began 11/11/2025 Review ended 12/02/2025 Published 12/08/2025 © Copyright 2025 Kimura et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98763 Open Access Original Article Combined Effects of Physical Function and Overall Condition on Functional Independence Measure Gains in Rehabilitation Ward Patients During the Recovery Phase Daisuke Kimura 1, Hiroki Bizen 2, Kenta Kunoh 3, Daiki Nakashima 1, Teruhumi Iitsuka 1 1. Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara, JPN 2. Department of Occupational Therapy, Faculty of Health Sciences, Kansai University of Health Sciences, Osaka, JPN 3. Department of Rehabilitation, Yamada Hospital, Gifu, JPN Corresponding author: Daisuke Kimura, [dkimura@naragakuen-u.jp](dkimura@naragakuen-u.jp) Abstract Background and objective In the context of Japan’s rapidly aging society, there is an increasing demand for effective rehabilitation strategies to support individuals with diminished physical function. This study aimed to identify the optimal combination of systemic condition and physical function indicators that most strongly influence functional independence measure (FIM) gains, a key outcome index in rehabilitation. Methods This retrospective study included 31 inpatients (mean age: 71.5 ± 13.6 years) with cerebrovascular or musculoskeletal diseases in a convalescent rehabilitation ward. Systemic condition was assessed using 14 blood biomarkers (e.g., mean corpuscular hemoglobin concentration (MCHC), albumin (Alb), and total protein (TP)), while physical function was evaluated using grip strength, knee extensor strength-to-weight ratio, the six-minute walk test, and the Berg Balance Scale. Random forest models with five-fold crossvalidation were used to identify predictors of FIM gain. Feature importance was assessed using the mean decrease in Gini (MDG) index, and a composite score was calculated to rank variable combinations. Results The mean FIM gain during hospitalization was 25.0 ± 17.1 points. The strongest individual predictors among systemic condition indicators were MCHC (MDG = 1.3607), Alb level (1 .0777), and TP (0 .8868) . For physical function, the most important variables were balance ability (2 . 1481), paralytic-side muscle strength (2 .0245), and walking ability (1 .9111) . Composite score analysis showed that the combination of “balance ability + MCHC” had the highest predictive value (score = 0 .6253), followed by “non-paralytic grip strength + MCHC”(0 .5754) and “balance ability + Alb”(0 .559) . Conclusions Our findings suggest that combining indicators of physical function, especially balance ability and grip strength, with systemic markers such as MCHC and Alb can enhance the prediction of functional recovery. The use of such combined indices may facilitate more tailored and efficient rehabilitation interventions. Notably, MCHC, a lesser-studied indicator in rehabilitation, showed high predictive value, highlighting the potential role of anemia-related biomarkers in optimizing functional outcomes. Although the sample size was small, this exploratory analysis provides hypothesis-generating insights that may inform future largescale rehabilitation studies. Categories: Physical Medicine & Rehabilitation Keywords: anemia, cerebrovascular disease, physical function, recovery, rehabilitation Introduction In Japan, the rapid progression of an aging population has led to an increase in the number of elderly individuals requiring assistance in daily living due to age-related declines in physical function and chronic illnesses. In this context, the importance of rehabilitation medicine in medical and nursing care settings has grown significantly, with a growing need t

FAQs

What was the main objective of this study?

To identify the optimal combination of systemic condition and physical function indicators that most strongly influences Functional Independence Measure (FIM) gains during rehabilitation.

How were systemic condition and physical function assessed?

Systemic condition was evaluated using 14 blood biomarkers, while physical function was assessed with grip strength, knee extensor strength-to-weight ratio, the six-minute walk test, and the Berg Balance Scale.

Which variables showed the strongest predictive value for FIM gains?

For systemic indicators, MCHC, albumin (Alb), and total protein (TP) were strongest. For physical function, balance ability, paralytic-side muscle strength, and walking ability were most important.

Sep 30, 2026

Uploaded by Himbo