Functional Independence Measure (FIM)

The FIM assesses physical and cognitive disability. It consists of two subscales, motor and socio-cognitive.

Number of items: 18

Procedure/Administration: The tool is completed by observation of performance.  The motor subscale includes 13 items: eating, grooming bathing, dressing upper extremity, dressing lower extremity, bowel management, bladder management, transfers to bed, chair or wheelchair, transfer to tub, toilet and shower, walking or wheelchair propulsion and stair climbing. The socio-cognitive subscale includes 5 items: comprehension, expression, social interaction, problem solving and memory.

How scored: Each item is scored on a 7 point ordinal scale ranging from 1 (total dependence) to a score of 7 (total independence). The scoring considers the use of adaptive equipment and/or the extent of personal assistance or supervision required to complete the task.  FIM motor, cognitive and/or total scores can be derived by summing items.

Interpretability: Total FIM scores range from 18 (totally dependent) to 126 (totally independent); motor scores range from 13 (total dependence) to 91 (total independence); and cognitive scores range from 5 (total dependence) to 35 (total independence).  Higher scores reflect fewer care hours required upon discharge (Heinemann et al. 1997; Hamilton et al. 1999).

Acceptability: The FIM is not SCI specific. It has limitations in sensitivity to component abilities within tasks for people with SCI. There is a ceiling effect with the socio-cognitive subscale for individuals with and it does not measure the social, psychological, or vocational impact of disability experienced by those living with SCI.

Languages: The FIM has been translated into 10 languages.

Usability: The FIM is used widely for research, clinical and administrative purposes. 

Time to administer: 45 minutes.

Time to score: N/a

Training required: Certification for FIM administration is required

Availability: Information on training can be obtained from http://www.udsmr.org/. See McDowell & Newell (1996) for a copy of the FIM.

Equipment required: None

Summary:

  • The FIM is often considered the gold standard for assessing ADLs.
  • Though it is the best researched measure of function, it may not be sensitive to the subtle important changes in function for SCI individuals.
  • As a result of the limitations of the FIM for use with individuals with SCI, the SCIM was developed and may perhaps be a better tool to use with SCI patients.

Psychometric Summary:

FIM

Reliability

Validity

Responsiveness

Results

Results

Results

Floor/ceiling

IC: Yellow light

TR/Inter O: Green light

Construct/Criterion: Green light

 

Red light

 

Floor/Ceiling: Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

  • Davidoff GN, Roth EJ, Haughton JS, Ardner MS. Cognitive dysfunction in spinal cord injury patients: sensitivity of the Functional Independence Measure subscales vs. neuropsychologic assessment. Arch Phys Med Rehabil 1990;71:326-329.
  • Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients Arch Phys Med Rehabil, 1993; 74: 531-536.
  • Granger CV, Hamilton BB, Keith RA et al. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil 1986;1:59-74.
  • Graves D. The construct validity and explanatory power of the AISA Motor Score and the FIM: implications for theoretical models of spinal cord injury Top Spinal Cord Inj Rehabil 2005;10:65-74.
  • Hall KM, Cohen ME, Wright J, Call M, Werner P. Characteristics of the Functional Independence Measure in traumatic spinal cord injury. Arch Phys Med Rehabil 1999;80:1471-1476.
  • Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehab Med 1994;26:115-119.
  • Hamilton BB, Deutsch A, Russell C, Fiedler RC, Granger CV. Relation of disability costs to function: spinal cord injury. Arch Phys Med Rehabil 1999;80:385-391.
  • Heinemann AW, Kirk P, Hastie BA Semik,P, Hamilton BB, Linacre JM, Wright BD, Granger C. Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury. Arch Phys Med Rehabil 1997;78:143-149.
  • McCabe MA, Granger CV. Content validity of a pediatric Functional Independence Measure. Appl Nurs Res 1990;3:120-122.
  • McDowell I, Newell C. Measuring Health. A Guide to Rating Scales and Questionnaires. Oxford University Press, New York NY, 1996.
  • Middleton JW, Harvey LA, Batty J, Cameron I, Quirk R, Winstanley J. Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury. Spinal Cord 2006; 44: 495-504.
  • Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996;77:1226-1232.