Functional Independence Measure (FIM): Difference between revisions

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== Objective  ==
== 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 


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, [[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).


== Intended Population  ==
* 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>


Patients with functional mobility impairments.  
== 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>.


== Method of Use  ==
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 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.  
== 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.


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


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|right]]
* Eating
* Grooming
* Bathing
* Dressing, upper body


<u>'''FIM Levels'''</u><ref name=":0" />
* Dressing, lower body
* Toileting
* Bladder management
* Bowel management
* Transfers - bed/chair/wheelchair
* Transfers - toilet
* Transfers - bath/shower
* Walk/[[Wheelchair Assessment - Assessment Interview|wheelchair]]
* Stairs


<br>
The cognition subscale includes:


'''No Helper'''
* Comprehension
* Expression
* Social interaction
* Problem solving
* [[Memory]]


7. Complete Independence&nbsp;
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>


(Timely, Safety)
FIM levels


6. Modified Independence
'''No Helper'''


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


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


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


(Subject = 100%)
'''Helper - Complete Dependence'''


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


(Subject = 75% or more)
Leave no blanks. Enter 1 if not testable due to risk.<ref name=":0" />


3. Moderate Assistance
The total score for the FIM


(Subject = 50% or more)  
* 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.


'''Helper - Complete Dependence''' 
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" />


2. Maximal Assistance
== Reliability and Validity ==


(Subject = 25% or more)
# 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>  
1. Total Assistance or not Testable
 
(Subject less than 25%)
 
<br>
 
*Leave no blanks. Enter 1 if not testable due to risk.
 
<br>
 
 
=== Reliability  ===
 
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  ===
 
The concurrent validity with Barthel Index (ICC &gt; 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<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>  


== References  ==
== References  ==
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[[Category:Activities of Daily Living]]
[[Category:Activities of Daily Living]]
[[Category:Older People/Geriatrics - Outcome Measures]]
[[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, Nikhil Benhur Abburi, Lucinda hampton, Kim Jackson, Evan Thomas, WikiSysop, Vidya Acharya, Nicole Hills, Lauren Lopez and Kapil Narale

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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