Functional Independence Measure (FIM): Difference between revisions

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== Objective  ==
== Objective  ==
[[Image:Functional Independence Measure.jpg|right|alt=|frameless|570x570px]]The Functional Independence Measure (FIM) is an instrument that was developed as a measure of disability for a variety of populations and is not specific to any diagnosis. The FIM instrument 


The Functional Independence Measure (FIM) is an 18-item measurement tool that explores an individual's physical, psychological and social function. This is par of Uniform Data System for Medical Rehabilitation (UDSMR)<ref name=":0">Linacre JM, Heinemann JW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil. 1994. 75: 127-132.</ref> The tool is used to assess a patient's level of disability as well as a change in patient status in response to rehabilitation or medical intervention.<ref name=":0" /><ref name=":1">Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993. 74: 566-573. </ref> The FIM uses the level of assistance an individual needs to grade functional status from total independence to total assistance 
* Includes measures of independence for self-care, including sphincter control, transfers, locomotion, communication, and social cognition<ref>Cameron MH, Monroe L. Physical Rehabilitation-E-Book: Evidence-based examination, evaluation, and intervention. Elsevier Health Sciences; 2007 Apr 5.Available: https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-independence-measure<nowiki/>(accessed 22.5.2021)</ref>. 
* Is an 18-item, seven-level, ordinal scale intended to be sensitive to changes over the course of a comprehensive inpatient medical rehabilitation program. 
* Uses the level of assistance an individual needs to grade functional status from total independence to total assistance). 
 
* The tool is used to assess a patient's level of disability as well as a change in patient status in response to rehabilitation or medical intervention.<ref name=":0">Linacre JM, Heinemann JW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil. 1994. 75: 127-132.</ref><ref name=":1">Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993. 74: 566-573. </ref>  


== Intended Population  ==
== Intended Population  ==
Designed to assess areas of dysfunction in activities that commonly occur in subjects with any progressive, reversible or stable neurologic, musculoskeletal, or other disorder ie patients with functional mobility impairments<ref>Elia AE, Graziella F, Albanese A. [https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-independence-measure 12 Clinical Trials of Botulinum Toxin in Adult Spasticity.] Botulinum Toxin E-Book: Therapeutic Clinical Practice and Science. 2009 Feb 18:148.Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-independence-measure<nowiki/>(accessed 22.5.2021)</ref>.
== Method of Use  ==


Patients with functional mobility impairments.  
The FIM is used by healthcare practitioners to assess and grade the functional status of a person based on the level of assistance he or she requires.


== Method of Use  ==
FIM™ is comprised of 18 items, grouped into 2 subscales - motor and cognition.
 
The motor subscale includes:


The FIM is used by healthcare practitioners to assess and grade the functional status of a person based on the level of assistance he or she requires. FIM scores range from 1 to 7. The grading categories range from "total assistance with helper = 1" to "complete independence with no helper=7". Irrespective of the use of any assistive device, the person is considered complete independence. Scores falling below 6 require another person for supervision or assistance.
* Eating
* Grooming
* Bathing
* Dressing, upper body


Tasks that are evaluated using the FIM include bowel and bladder control, transfers, locomotion, communication, social cognition as well as the following six self-care activities:<ref name=":0" /><ref name=":0" /> <ref name=":1" />
* Dressing, lower body
*Feeding
* Toileting
*Grooming
* Bladder management
*Bathing
* Bowel management
*Upper Body Dressing
* Transfers - bed/chair/wheelchair
*Lower Body Dressing
* Transfers - toilet
*Toileting <br>
* Transfers - bath/shower
* Walk/wheelchair
* Stairs


The FIM measures what an individual can perform and not what that person could do under certain circumstances. <br>
The cognition subscale includes:


[[Image:Functional Independence Measure.jpg|right]]
* Comprehension
* Expression
* Social interaction
* Problem solving
* Memory


<u>'''FIM Levels'''</u><ref name=":0" />
Each item is scored on a 7 point ordinal scale, ranging from a score of 1 to a score of 7. The higher the score, the more independent the patient is in performing the task associated with that item.


<br>
FIM levels


'''No Helper'''  
'''No Helper'''


7. Complete Independence&nbsp;  
7. Complete Independence&nbsp;  
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(Subject less than 25%)  
(Subject less than 25%)  
Leave no blanks. Enter 1 if not testable due to risk.<ref name=":0" />
The total score for the FIM motor subscale (the sum of the individual motor subscale items) will be a value between 13 and 91.
The total score for the FIM cognition subscale (the sum of the individual cognition subscale items) will be a value between 5 and 35.
The total score for the FIM instrument (the sum of the motor and cognition subscale scores) will be a value between 18 and 126.


<br>  
<br>  


*Leave no blanks. Enter 1 if not testable due to risk.  
[[Image:Functional Independence Measure.jpg|right]]


<br>  
<br>  
&nbsp;
<br>




Revision as of 07:29, 22 May 2021

Original Editor - Ajay Upadhyay

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Objective[edit | edit source]

The Functional Independence Measure (FIM) is an instrument that was developed as a measure of disability for a variety of populations and is not specific to any diagnosis. The FIM instrument

  • Includes measures of independence for self-care, including sphincter control, transfers, locomotion, communication, and social cognition[1].
  • Is an 18-item, seven-level, ordinal scale intended to be sensitive to changes over the course of a comprehensive inpatient medical rehabilitation program.
  • Uses the level of assistance an individual needs to grade functional status from total independence to total assistance).
  • The tool is used to assess a patient's level of disability as well as a change in patient status in response to rehabilitation or medical intervention.[2][3]

Intended Population[edit | edit source]

Designed to assess areas of dysfunction in activities that commonly occur in subjects with any progressive, reversible or stable neurologic, musculoskeletal, or other disorder ie patients with functional mobility impairments[4].

Method of Use[edit | edit source]

The FIM is used by healthcare practitioners to assess and grade the functional status of a person based on the level of assistance he or she requires.

FIM™ is comprised of 18 items, grouped into 2 subscales - motor and cognition.

The motor subscale includes:

  • Eating
  • Grooming
  • Bathing
  • Dressing, upper body
  • Dressing, lower body
  • Toileting
  • Bladder management
  • Bowel management
  • Transfers - bed/chair/wheelchair
  • Transfers - toilet
  • Transfers - bath/shower
  • Walk/wheelchair
  • Stairs

The cognition subscale includes:

  • Comprehension
  • Expression
  • Social interaction
  • Problem solving
  • Memory

Each item is scored on a 7 point ordinal scale, ranging from a score of 1 to a score of 7. The higher the score, the more independent the patient is in performing the task associated with that item.

FIM levels

No Helper

7. Complete Independence 

(Timely, Safety)

6. Modified Independence

(Device)

Helper - Modified Dependence

5. Supervision 

(Subject = 100%)

4. Minimal Assistance

(Subject = 75% or more)

3. Moderate Assistance

(Subject = 50% or more)

Helper - Complete Dependence

2. Maximal Assistance

(Subject = 25% or more)

1. Total Assistance or not Testable

(Subject less than 25%)

Leave no blanks. Enter 1 if not testable due to risk.[2]

The total score for the FIM motor subscale (the sum of the individual motor subscale items) will be a value between 13 and 91.

The total score for the FIM cognition subscale (the sum of the individual cognition subscale items) will be a value between 5 and 35.

The total score for the FIM instrument (the sum of the motor and cognition subscale scores) will be a value between 18 and 126.


Functional Independence Measure.jpg



 


Reliability[edit | edit source]

Inter-Rater Reliability of FIM has been established at an acceptable psychometric performance (Intraclass co-relation coefficients ranging from 0.86 to 0.88)

Validity[edit | edit source]

The concurrent validity with Barthel Index (ICC > 0.83), Gosman-Hedstrom and Svenson have shown strong construct validity between items on Barthel Index and items on the FIM the measure functional limitations[5]


References[edit | edit source]

  1. ↑ Cameron MH, Monroe L. Physical Rehabilitation-E-Book: Evidence-based examination, evaluation, and intervention. Elsevier Health Sciences; 2007 Apr 5.Available: https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-independence-measure(accessed 22.5.2021)
  2. ↑ 2.0 2.1 Linacre JM, Heinemann JW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil. 1994. 75: 127-132.
  3. ↑ Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993. 74: 566-573.
  4. ↑ Elia AE, Graziella F, Albanese A. 12 Clinical Trials of Botulinum Toxin in Adult Spasticity. Botulinum Toxin E-Book: Therapeutic Clinical Practice and Science. 2009 Feb 18:148.Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-independence-measure(accessed 22.5.2021)
  5. ↑ Gosman-Hedstrom, G, and Svensson, E: Parallel reliability of the Functional Independence Measure and the Barthel index ADLIndex. Psychiatry 73:188, 2000
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