Functional Independence Measure (FIM): Difference between revisions

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'''Original Editor '''- [[User:Ajay Upadhyay|Ajay Upadhyay]]  
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== Objective<br>  ==


The Functional Independence Measure (FIM ) is an 18- Item of physical, psychological and social function.  
== Objective  ==
[[File:PP Disability Images.jpg|right|frameless|350x350px]]
The Functional Independence Measure (FIM) is an instrument that was developed as a measure of [[International Classification of Functioning, Disability and Health (ICF)|disability]] for a variety of populations and is not specific to any diagnosis. The FIM instrument 


== Intended Population<br> ==
* Includes measures of independence for self-care, including sphincter control, transfers, [[Ageing and the Locomotor System|locomotion]], [[Communication in Healthcare|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).


In any motor impairment associated with any condition
* The tool is used to assess a patient's level of disability as well as a change in patient status in response to [[Introduction to Rehabilitation|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>


== Method of Use  ==
== Intended Population ==
Designed to assess areas of dysfunction in activities that commonly occur in subjects with any progressive, reversible or stable [[Neurological Disorders|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>.


The FIM uses the level of assistance an individual needs to grade the functional status of a person. Grading is given as total independence to total assistance. Irrespective of the use of any assistive device, the person is considered complete independence.  
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.


The list includes six self care activities:
== Method of Use ==
[[Image:Functional Independence Measure.jpg|right|alt=|frameless|570x570px]]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. 


Feeding <br> Grooming <br> Bathing <br> Upper Body Dressing <br> Lower Body Dressing <br> Toileting <br>
FIM™ is comprised of 18 items, grouped into 2 subscales - motor and cognition.


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


[[Image:Functional_Independence_Measure.jpg|left]]
* Eating
* Grooming
* Bathing
* Dressing, upper body


<u>'''FIM Levels'''</u>
* Dressing, lower body
* Toileting
* Bladder management
* Bowel management
* Transfers - bed/chair/wheelchair
* Transfers - toilet
* Transfers - bath/shower
* Walk/[[Wheelchair Assessment - Assessment Interview|wheelchair]]
* Stairs


The cognition subscale includes:


* Comprehension
* Expression
* Social interaction
* Problem solving
* [[Memory]]


'''No Helper'''
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.<ref name=":2">AIHW FIM Available from:https://meteor.aihw.gov.au/content/index.phtml/itemId/495857 (accessed 22.5.20210</ref>


7. Complete Independence&nbsp;
FIM levels


(Timely, Safety)
'''No Helper'''


6. Modified Independence
* 7. Complete Independence&nbsp; (Timely, Safety)
 
* 6. Modified Independence (Device)  
(Device)


'''Helper - Modified Dependence'''
'''Helper - Modified Dependence'''


5. Supervision&nbsp;
* 5. Supervision&nbsp;(Subject = 100%)
 
* 4. Minimal Assistance (Subject = 75% or more)  
(Subject = 100%)
* 3. Moderate Assistance (Subject = 50% or more)  
 
4. Minimal Assistance
 
(Subject = 75% or more)
 
3. Moderate Assistance
 
(Subject = 50% or more)


'''Helper - Complete Dependence'''
'''Helper - Complete Dependence'''
2. Maximal Assistance
(Subject = 25% or more)
1. Total Assistance or not Testable


(Subject less than 25%)
* 2. Maximal Assistance (Subject = 25% or more)
* 1. Total Assistance or not Testable (Subject less than 25%)  


<br>
Leave no blanks. Enter 1 if not testable due to risk.<ref name=":0" />


*Leave no blanks. Enter 1 if not testable due to risk.&nbsp;
The total score for the FIM


== Reference<br>  ==
* 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.


== Evidence  ==
The total score for the FIM instrument (the sum of the motor and cognition subscale scores) will be a value between 18 and 126.<ref name=":2" />


=== Reliability ===
== Reliability and Validity ==


Inter Rater Reliability (Intra class co relation coefficients ranging from 0.86 to 0.88)  
# Inter-Rater Reliability of FIM has been established at an acceptable [[Psychometric Properties|psychometric]] performance (Intraclass co-relation coefficients ranging from 0.86 to 0.88)
# The concurrent validity with [[Barthel Index]] (ICC &gt; 0.83) have shown strong construct validity between items on Barthel Index and items on the FIM the measure functional limitations<ref>Gosman-Hedstrom, G, and Svensson, E: Parallel reliability of the Functional Independence Measure and the Barthel index ADLIndex. Psychiatry 73:188, 2000</ref><br>


=== Validity  ===
The concurrent validity with Barthel Index (ICC &gt; 0.83)
<br>
=== Responsiveness  ===
=== Miscellaneous<br>  ===
== Links  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1j_AM05Yvo4jA_yxyYDDCu106OfgUdefgWD1wpcIpRroaoWQeD|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
<references />


<references />
[[Category:Outcome Measures]]
[[Category:Older People/Geriatrics]]
[[Category:Activities of Daily Living]]
[[Category:Older People/Geriatrics - Outcome Measures]]
[[Category:Stroke]]
[[Category:Stroke - Assessment and Examination]]
[[Category:Spinal Cord Injuries]]

Latest revision as of 06:04, 7 February 2023

Original Editor - Ajay Upadhyay

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

Objective[edit | edit source]

PP Disability Images.jpg

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].

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[edit | edit source]

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.[5]

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.
  • 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.[5]

Reliability and Validity[edit | edit source]

  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[6]

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. ↑ 5.0 5.1 AIHW FIM Available from:https://meteor.aihw.gov.au/content/index.phtml/itemId/495857 (accessed 22.5.20210
  6. ↑ 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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