NINDS CDE Notice of Copyright
Functional Independence Measure
Functional Independence Measure
The FIM is proprietary. For further information about obtaining the scale, syllabus, and training materials please contact:
Supplemental: Chiari I Malformation (CM), Multiple Sclerosis (MS), Stroke, and Traumatic Brain Injury (TBI)
Exploratory: Cerebral Palsy (CP), Freidreich's Ataxia (FA) and Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
|Short Description of Instrument||
Purpose: The FIM measures degree of independence in activities of self-care, sphincter control, transfers, locomotion, communication, and cognition.
Overview: The FIM emerged from a thorough developmental process overseen by a National Task Force of rehabilitation research. The National Task force reviewed 36 published and unpublished functional assessment scales before agreeing on an instrument. The FIM is an 18-item ordinal scale, used with all diagnoses within a rehabilitation population. It is viewed as most useful for assessment of progress during inpatient rehabilitation.
FIM was originally an acronym for "Functional Independence Measure". It is still often cited as this in the literature. The current owners of the FIM instrument have decided that the acronym FIM no longer stands for anything and should be referred to only as FIM.
Time: Evaluation time is 20-30 minutes.
The FIM may be completed by rehabilitation clinicians as an observational scale, or by trained paraprofessionals or family members. It can be administered by trained interviewers as a self report or proxy report instrument, in person or by phone.
FIM certification is available and required to officially utilize the tool. A detailed manual guides scoring, based on operationally-defined functional abilities. Most appropriate for Severe and Moderate Disability levels of GOSE; ceiling effects limit utility in Good Recovery.
The FIM is imbedded in the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI). Thus if the IRF-PAI is administered it is not necessary to separately administer the FIM.
The alpha FIM is a subset that has been used in the acute patient setting to assess which patients are appropriate for discharge to a rehabilitation setting. The alpha FIM may be worth exploring in Phase III trials that include assessments of appropriateness of different post-discharge destinations.
|Scoring and Psychometric Properties||
Scores range from 1 (total or >75% assistance) to 7 (complete independence). The total of the 18 items is the patient's total score, which ranges from 18-126. Scores may be used raw or converted to interval scores.
Psychometric Properties: Inter-rater reliability was found to be high for the total score and moderate to substantial for items assessing physical disability, except for the item concerned with assessing independence in walking or in wheelchair. The inter-rater agreement of FIM items in the communication and social cognition subsections was only fair (Hamilton et al., 1991). The internal consistency of the FIM assessment scale was found to be high overall and for patients grouped by impairment, but low for the locomotion subscale (Dodds et al., 1993). Minimal clinically importance difference relative to physician assessment has been established for total score and motor and cognitive subscores in post inpatient rehabilitation stroke patients (Beninato et al., 2006).
Granger CV. The emerging science of functional assessment: our tool for outcomes analysis. Arch Phys Med Rehabil 1998;79(3):235-240.
Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil. 2006;87(1):32-39.
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(5):531-536.
Hamilton BB, Laughlin JA, Granger CV, Kayton RM. Interrater agreement of the seven-level Functional Independence Measure (FIM). (abstract) Arch Phys Med Rehabil 1991;72:790.
McDowell I, Newell C. Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press, 1987.
Wright, J. (2000). The FIM(TM). The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/FIM (accessed October 21, 2016).
Thorpe ER, Garrett KB, Smith AM, Reneker JC, Phillips RS. Outcome Measure Scores Predict Discharge Destination in Patients With Acute and Subacute Stroke: A Systematic Review and Series of Meta-analyses. J Neurol Phys Ther. 2018;42(1):2-11.