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Functional Independence Measure
Availability
The FIM is proprietary. For further information about obtaining the scale, syllabus, and training materials please contact:
Classification
NeuroRehab Supplemental - Highly Recommended:
Recommendations for Use: Indicated for studies requiring a measure of Activities of Daily Living.
 
Supplemental: Chiari I Malformation (CM), Multiple Sclerosis (MS), Stroke, and Traumatic Brain Injury (TBI)
 
Exploratory: Cerebral Palsy (CP), Friedreich's Ataxia (FA) and Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Purpose: The FIM measures the capacity for 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 The National Task force reviewed 36 published and unpublished functional assessment scales before agreeing on an instrument.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 scale with each item structured in an ordinal scale. It can be used with all diagnoses within a rehabilitation population. It is viewed as most useful for assessment of progress during inpatient rehabilitation.
 
Time: Evaluation time is 20-30 minutes.
Comments/Special Instructions
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.
 
Prior to 2020, the FIM was imbedded in the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI). Subsequently, Section GG of the Standardized Patient Assessment Data Elements replaced the FIM for alignment with other post-acute care programs. The FIM can no longer be extracted from the IRF-PAI.
 
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.
 
NeuroRehab Specific: The FIM is a widely used observational/self-report measure using objective criteria for scoring and therapist or patient/family observations. It is most appropriate for inpatient rehabilitation and during the first year or so after discharge. If the administrator is trained, the FIM can be used as a performance-based measure.
Scoring and Psychometric Properties
Scoring: 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).
Rationale/Justification
NeuroRehab Specific:
Advantages: Very strong use in both inpatient rehab and longitudinal follow-up research. Strong psychometrics, reliability, sensitive to change, very extensive literature. FIM scores based on observations by therapists, trained research staff or can be provided by self-report.
 
Disadvantages: Training needs to be purchased, no longer required to be measured in inpatient rehab. Several important ADL activities are not included: medication; sleep; personal care device management, e.g., insulin shots, hearing aids. The FIM may manifest ceiling or floor effects and may not be appropriate for measuring individuals outside their range of assessment.
References
Granger CV. The emerging science of functional assessment: our tool for outcomes analysis. Arch Phys Med Rehabil. 1998;79(3):235-240.
 
Additional References:
 
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.
 
Document last updated January 2022