Item-level analysis and network analysis of the functional independence measure cognitive items at discharge after acute stroke

Abstract

Purpose This study characterized item-level profiles and inter-item relationships of the five Functional Independence Measure (FIM) cognitive items at discharge after acute stroke, using clinically anchored coding and network analysis.Methods Discharge FIM cognition scores were retrospectively analyzed in 974 consecutive patients. Items were dichotomized into supervision-or-better (scores 5–7) versus requiring assistance beyond supervision (scores 1–4). Attainment rates, item–rest correlations, and conditional response probability curves were described. Original 7-point scores were used for supplementary item-level and dimensionality analyses and ordinal partial-correlation network estimation. Edge-weight accuracy and centrality stability were assessed by bootstrapping, with Pearson-based sensitivity analysis.Results Supervision-or-better attainment ranged from 67.0% to 77.7%, and item–rest correlations ranged from 0.79 to 0.91. Analyses supported a dominant common dimension. The ordinal network showed two major conditional associations: comprehension–expression (r = 0.71) and memory–problem solving (r = 0.55). Comprehension showed the highest strength centrality, with good stability (CS coefficient = 0.677). Stronger edges were estimated more precisely, with a comparable Pearson-based pattern.Conclusion Discharge FIM cognition profiles demonstrated clinically interpretable item-level heterogeneity and a conditional association structure dominated by two edges. These findings provide a discharge-oriented descriptive framework warranting replication and longitudinal validation against external outcomes.