Functional Independence Measure (FIM)

Clinical Summary

Jump to: Tool Description | Interpretability | Measurement Property Summary

Tool Description

  • often considered the gold standard for assessing basic activities of daily living (ex. self care).
  • consists of two subscales, motor and socio-cognitive. 

ICF Domain:

Activity – Subcategory: Self-Care

Number of Items:

18

Brief Instructions for Administration & Scoring

Administration:

  • clinician-administered; 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.
  • administration is typically conducted by interdisciplinary team members
  • Administration usually takes approximately 45 minutes, though short and phone versions also exist and may take more/less time to administer.

Equipment:Items that the patient uses to carry out activities of daily living.

Scoring:

  • 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. If assistive equipment (ex. raised toilet seat) is used, the individual cannot achieve a score of 7 on the item.
  • FIM motor, cognitive and/or total scores can be derived by summing items.
  • 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).  

Interpretability

MCID: not established for the SCI population, but for an acute stroke sample, MCID = 22 points (for FIM Total score), 17 points (for FIM-Motor subscale) and 3 points (for FIM-Cognitive subscale). [Beninato et al. 2006, “Determination of the minimal clinically important difference in the FIM instrument in patients with stroke”, n=113]
SEM: not established
MDC: not established

  • Higher scores reflect fewer care hours required upon discharge.
  • No normative data for the SCI population has been established.
  • Published data for the SCI population is available for comparison for the FIM (see Interpretability section of the respective Study Details sheets).

Languages:

English, German, Italian, Spanish, Swedish, Finnish, Portuguese, Afrikaans, Turkish and French.

Training Required:

Certification for FIM administration is required.

Availability:

Can be purchased through http://www.udsmr.org/WebModules/FIM/Fim_About.aspx

Clinical Considerations

  • Though it is the best researched measure of basic function, it may not be sensitive to the subtle important changes in function for SCI individuals.
  • 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.
  • Punitive scoring for individuals who use assistive technology occurs although these individuals may be independent
  • Typically requires individuals from a number of different backgrounds (nurse, physical therapy, occupational therapy) to complete

Measurement Property Summary

# of studies reporting psychometric properties: 27

Reliability:

  • Overall reliability is excellent for the total FIM (ICC=0.96), the FIM motor scale (ICC=0.90-0.96) and the FIM cognitive scale (ICC=0.91-0.98).
  • Test-retest reliability of the FIM is excellent (ICC=0.89).

[Segal et al. 1993, Kucukdeveci et al. 2001, Lundgren-Nilsson et al. 2006, Morganti et al. 2005, Hall et al. 1999, Hamilton 1994, Dodds 1993, Nilsson 2005, Hamilton 1999, Heinemann et al. 1997]

Validity:

  • Correlation of the FIM is excellent with the:
    • Quadriplegia Index of Function (Spearman’s ρ= 0.97)
    • Quadriplegia Index of Function – Modified (Spearman’s ρ=0.93)
    • Upper Extremity Motor Score (Spearman’s ρ=0.84)
    • Rivermead Mobility Index (Spearman’s ρ=0.9)
    • Barthel Index (Spearman’s ρ=0.7)
    • Spinal Cord Independence Measure (Spearman’s ρ=0.8)
    • Walking Index for Spinal Cord Injury (Spearman’s ρ=0.70-0.77)
    • Berg Balance Scale (Spearman’s ρ=0.72-0.77)
    • American Spinal Injury Association (ASIA) motor score (Spearman’s ρ=0.91)
  • Correlation of the FIM is adequate with the:
    • ASIA light touch (Spearman’s ρ=0.58)
    • ASIA pinprick (Spearman’s ρ=0.55)
    • 50-Foot Walking Speed Test (Spearman’s ρ=0.57).

[Marino et al. 1993, Yavuz et al. 1998, Dijkers et al. 1999, Beninato et al. 2004, Kucukdeveci et al. 2011, Dijkers 1999, Donnelly et al. 2004, Ditunno et al. 2007, Middleton et al. 2006, Itzkovich et al. 2007, Lawton et al. 2006, Morganti et al. 2005, Marino 2004, Heinemann 1997, Graves 2005, Dodds 1993, Nilsson 2005, Hamilton 1999, Marino 1998, Mulcahey et al. 2004, Anderson et al. 2011]

Responsiveness:

  • Significant improvements in FIM score were detected between admission and discharge FIM scores (effect size for total FIM = 1.36).

[Middleton et al. 2006, Spooren et al. 2006, Dodds et al. 1993, Anderson et al. 2011]

Floor/ceiling effect:

  • Ceiling effects were reported on FIM-cognition items.
  • For bed transfer, toilet transfer and bath transfer, a ceiling effect was detected in the paraplegia group and a floor effect was detected in the tetraplegic group.

[Davidoff 1990, Middleton et al. 2006, Hall et al. 1999]

Reviewer

Dr. William Miller, Christie Chan

Date Last Updated:

 Feb 1, 2013