Functional Independence Measure (FIM)

Original Editor - Ajay Upadhyay

Top Contributors - Gayatri Jadav Upadhyay, Ajay Upadhyay, Laura Ritchie, Nikhil Benhur Abburi, Lucinda hampton, Kim Jackson, WikiSysop, Vidya Acharya, Nicole Hills, Lauren Lopez, Kapil Narale and Evan Thomas

Objective

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.
• 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.

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.

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

Guide for use: Patient function is assessed using the FIM™ instrument at the start of a rehabilitation episode of care and at the end of a rehabilitation episode of care. Admission assessment is collected within 72 hours of the start of a rehabilitation episode. Discharge assessment is collected within 72 hours prior to the end of a rehabilitation episode.

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.

The total score for the FIM

• motor subscale (the sum of the individual motor subscale items) will be a value between 13 and 91.
• 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.

Reliability and Validity

1. Inter-Rater Reliability of FIM has been established at an acceptable psychometric performance (Intraclass co-relation coefficients ranging from 0.86 to 0.88)
2. The concurrent validity with Barthel Index (ICC > 0.83) have shown strong construct validity between items on Barthel Index and items on the FIM the measure functional limitations