Functional Independence Measure (FIM)

Definition

The Functional Independence Measure (FIM) is a 18-item scale developed by Keith et al. (1987) to measure the functional independence of patients in rehabilitation settings. The FIM assesses six areas of function:

  • Self-care: This domain assesses the patient’s ability to perform basic self-care tasks, such as eating, bathing, and grooming.
  • Sphincter control: This domain assesses the patient’s ability to control their bladder and bowels.
  • Transfers: This domain assesses the patient’s ability to move from one place to another, such as from bed to chair or from wheelchair to toilet.
  • Locomotion: This domain assesses the patient’s ability to walk or use a wheelchair.
  • Communication: This domain assesses the patient’s ability to communicate, both verbally and nonverbally.
  • Social cognition: This domain assesses the patient’s ability to interact with others in a socially appropriate manner.

Reliability

The FIM has good interrater reliability, with intraclass correlation coefficients (ICCs) ranging from .80 to .95 (Keith et al., 1987). The FIM also has good test-retest reliability, with ICCs ranging from .75 to .90 (Keith et al., 1987).

Validity

The FIM has good construct validity. It has been shown to correlate with other measures of functional independence, such as the Barthel Index (Mahoney & Barthel, 1965) and the Katz Activities of Daily Living Scale (Katz et al., 1963). The FIM has also been shown to be sensitive to change in functional independence over time.

Use

The FIM is a useful tool for measuring the functional independence of patients in rehabilitation settings. It can be used to track changes in functional independence over time, to compare the functional independence of different groups of patients, and to evaluate the effectiveness of rehabilitation interventions.

Limitations

The FIM is a clinician-administered scale, which means that it requires training to use. Additionally, the FIM is a relatively new scale, and its use in other cultures may be limited.

Overall

The FIM is a well-validated scale for measuring the functional independence of patients in rehabilitation settings. It is a useful tool for clinicians who are interested in assessing and improving the functional independence of their patients.

Functional Independence Measure (FIM)

Granger and Hamilton‚ 1987
SELF-CARE
Eating. Includes use of suitable utensils to bring food to mouth‚ chewing and swallowing‚ once mealis appropriately prepared.
Grooming. Includes oral care‚ hair grooming‚ washing hands and face‚ and either sha‎ving or applying makeup.
Bathing. Includes bathing the body from the neck down (excluding the back)‚ either tub‚ shower or sponge/bed bath. Performs safely.
Dressing—Upper Body. Includes dressing above the waist as well as donning and removing prosthesis or orthosis when applicable.
Dressing—Lower Body. Includes dressing from the waist down as well as donning or removing prosthesis or orthosis when applicable.
Toileting. Includes maintaining perineal hygiene and adjusting clothing before and after toilet or bed pan use. Performs safely.
SPHINCTER CONTROL
Bladder Management. Includes complete intentional control of urinary bladder and use of equipment or agents necessary for bladder control.
Bowel Management. Includes complete intentional control of bowel movement and use of equipment or agents necessary for bowel control.
MOBILITY
Transfers: Bed‚ Chair‚ Wheelchair. Includes all aspects of transferring to and from bed‚ chair‚ and wheelchair‚ and coming to a standing position‚ if walking is the typical mode of locomotion.
Transfer: Toilet. Includes getting on and off a toilet.
Transfers: Tub or Shower. Includes getting into and out of a tub or shower stall.
LOCOMOTION
Walking or Using Wheelchair. Includes walking‚ once in a standing position‚ or using a wheelchair‚ once in a seated position‚ on a level surface.
Check most frequent mode of locomotion. If both are about equal‚ check W and C. If initiating a rehabilitation program‚ check the mode for which training is intended.
( ) W = Walking ( )C = Wheelchair
Stairs. Goes up and down 12 to 14 stairs (one flight) indoors.
COMMUNICATION
Comprehension. Includes understanding of either auditory or visual communication (e.g. writing‚ sign language‚ gestures).
Check and evaluate the most usual mode of comprehension. If both are about equally used‚ check A and V.
( )A = Auditory ( )V = Visual
Expression. Includes clear vocal or non-vocal expression of language. This item includes both intelligible speech or clear expression of language using writing or a communication device.
Check and evaluate the most usual mode of expression.
If both are about equally used‚ check V and N.
( )V = Vocal ( )N = Nonvocal
SOCIAL COGNITION
Social Interaction. Includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one’s own needs together with the needs of others.
Problem Solving. Includes skills related to solving problems of daily living. This means making reasonable‚ safe‚ and timely decisions regarding financial‚ social and personal affairs and initiating‚ sequencing and self-correcting tasks and activities to solve the problems.
Memory. Includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. It includes ability to store and retrieve information‚ particularly verbal and visual. A deficit in memory impairs learning as well as performance of tasks.
DESCRIPTION OF THE LEVELS OF FUNCTION AND THEIR SCORES
INDEPENDENT—Another person is not required for the activity (NO HELPER).
7 Complete Independence—All of the tasks described as making up the activity are typically performed safely‚ without modification‚ assistive devices‚ or aids‚ and within a reasonable time.
6 Modified Independence—Activity requires any one or more than one of the following: an assistive device‚ more than reasonable time‚ or there are safety (risk) considerations.
DEPENDENT—Another person is required for either supervision or physical assistance in order for the activity to be performed‚ or it is not performed (REQUIRES HELPER).
MODIFIED DEPENDENCE—The subject expends half (50%) or more of the effort. The levels of assistance required are:
5 Supervision or setup—Subject requires no more help than standby‚ cuing or coaxing‚ without physical contact. Or‚ helper sets up needed items or applies orthoses.
4 Minimal contact assistance—With physical contact the subject requires no more help than touching‚ or subject expends 75% or more of the effort.
3 Moderate assistance—Subject requires more help than touching‚ or expends half (50%) or more (up to 75%) of the effort.
COMPLETE DEPENDENCE—The subject expends less than half (less than 50%) of the effort. Maximal or total assistance is required‚ or the activity is not performed. The levels of assistance required are:
2 Maximal assistance—Subject expends less than 50% of the effort‚ but at least 25%.
1 Total assistance—Subject expends less than 25% of the effort.

Hamilton‚ BB.‚ Granger‚ CV.‚ Sherwin‚ FS.‚ et al. (1987). A uniform national data system for medical rehabilitation. In: Fuhrer MJ‚ ed. Rehabilitation outcomes: analysis and measurement. Baltimore: Paul H. Brookes‚ 137–147.

Granger‚ CV.‚ Cotter‚ AC.‚ Hamilton‚ BB.‚ et al. (1990). Functional assessment scales: a study of persons with multiple sclerosis. Arch Phys Med Rehabil‚ 71:870–875.

Granger‚ CV.‚ Hamilton‚ BB.‚ Keith‚ RA.‚ et al. (1986). Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil‚ 1:59–74.

Ottenbacher‚ KJ.‚ Hsu‚ Y.‚ Granger‚ CV.‚ et al. (1996). The reliability of the Functional Independence Measure: a quantitative review. Arch Phys Med Rehabil‚ 77:1226–1232.

McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS

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Related terms:

  1. Index of Independence in Activities of Daily Living (Index of ADL)
  2. MORAL INDEPENDENCE
  3. Global Measure of Equity and Multi-Trait Measure of Equity: Measuring Equity in Close Relationships
  4. Functional Assessment Inventory (FAI)
  5. Duke-UNC Functional Social Support Questionnaire (DUFSS)
  6. Functional Social Support Questionnaire
  7. Functional MRI (fMRI)
  8. Functional Tolerance
  9. Functional Analytic Psychotherapy
  10. FUNCTIONAL ASYMMETRY