300 Section - Bed Mobility Predicts Mortality in Acutely Hospitalized Patients with Cancer: A Retrospective Study

Decline in or lower discharge bed mobility Functional Independence Measure (FIM) scores are associated with mortality in cancer patients undergoing inpatient rehabilitation; however, the prognostic value of bed mobility in the acute care setting has not been explored. We hypothesized that bed mobility predicts mortality among hospitalized cancer patients.

Design:

We performed a retrospective chart review of cancer patients admitted to acute care between January and March 2020 who received physical or occupational therapy evaluations. FIM scores were extracted from therapy notes for sit-to-supine, supine-to-sit, and scooting tasks. Unadjusted Cox proportional hazards models assessed time to death within 180 days of discharge. Receiver operating characteristic (ROC) analyses with Youden’s J statistic identified functional thresholds. Analyses were conducted for the full cohort and stratified by patients with repeated assessments versus a single assessment per task.

Results:

Among 529 patients, 45% died within 180 days of discharge. Across the full cohort, lower first-recorded FIM scores across bed mobility tasks were associated with increased mortality. Among patients with repeated assessments, the strongest associations were observed for sit-to-supine: lower last-recorded FIM (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.73–0.88, p < 0.001) and greater FIM decline (HR 0.71, 95% CI 0.63–0.79, p < 0.001) were associated with higher mortality risk. ROC analyses demonstrated moderate discrimination (AUC 0.68 Youden J 0.29 for last-recorded FIM; AUC 0.69, Youden J 0.25 for FIM decline). Similar findings were observed for supine-to-sit transfers, with lower last-recorded FIM and FIM decline associated with mortality (HR 0.75, 95% CI 0.68–0.82, p < 0.001) and AUC/Youden Js of 0.68/0.28 and 0.66/0.22, respectively.

Conclusion:

Low discharge and declining bed mobility FIM scores are associated with increased 180-day mortality in hospitalized patients with cancer. Bed mobility may serve as a useful marker for prognostication and goals-of-care discussion in acute care and warrants prospective validation.