Functional Independence Measure (FIM): A Comprehensive Review
Abstract
Functional Independence Measure (FIM) is an 18-item measure designed to assess functional capacity after a neurological event such as a stroke, traumatic brain injury, or spinal cord injury. This review provides an overview of the FIM, its application in various settings, and the evidence to support its use. The FIM has been used to assess the need for rehabilitation services, measure progress over time, and compare outcomes in different settings or between different interventions. The FIM has good inter-rater reliability, internal consistency, and test-retest reliability, and is sensitive to changes in functional status. However, there is a need for further research to determine the validity of the FIM in different settings and for different populations.
Introduction
Functional Independence Measure (FIM) is a widely used 18-item measure designed to assess functional capacity following neurological events such as stroke, traumatic brain injury, and spinal cord injury (SCI). The FIM was developed by the Rehabilitation Institute of Chicago in 1981 and has since been used in a variety of settings, including acute care, inpatient rehabilitation, and outpatient rehabilitation [1]. The FIM has been used to measure functional capacity, assess the need for rehabilitation services, measure progress over time, and compare outcomes in different settings or between different interventions. This paper provides an overview of the FIM, its application in various settings, and the evidence to support its use.
Description of the FIM
The FIM is an 18-item measure that assesses the functional ability of individuals with neurological impairments. The items are divided into seven domains: self-care, sphincter control, mobility, communication, social cognition, and performance of activities of daily living (ADLs) [1]. Each item is scored on a 7-point scale with higher scores indicating greater levels of independence. Total scores range from 18 (total dependence) to 126 (total independence).
The FIM has been adapted for the assessment of pediatric patients, and the FIM-Pediatric (FIM-P) was developed in 1994 for use with children aged 0-18 years [2]. The FIM-P is an 18-item measure that assesses the functional ability of children with neurological impairments. Each item is scored on a 7-point scale with higher scores indicating greater levels of independence. Total scores range from 18 (total dependence) to 126 (total independence).
Evidence for the Use of the FIM
The FIM has good inter-rater reliability, internal consistency, and test-retest reliability, and is sensitive to changes in functional status [3]. The FIM has been used in a variety of settings, including acute care, inpatient rehabilitation, and outpatient rehabilitation. The FIM has been shown to be a valid and reliable measure of functional capacity in adults with neurological impairments [4].
The FIM-P has been shown to be a reliable measure of functional capacity in children aged 0-18 years [5]. The FIM-P has been used to assess functional capacity in children with congenital disorders, acquired neurological disorders, and developmental disabilities.
Conclusion
The FIM is a widely used measure of functional capacity in adults and children with neurological impairments. The FIM has good inter-rater reliability, internal consistency, and test-retest reliability, and is sensitive to changes in functional status. The FIM-P is a reliable measure of functional capacity in children aged 0-18 years. However, there is a need for further research to determine the validity of the FIM in different settings and for different populations.
References
[1] Granger, C. V., Hamilton, B. B., Fiedler, R. C., & Linacre, J. M. (1984). The functional independence measure: a new tool for rehabilitation. Archives of Physical Medicine and Rehabilitation, 65(1), 71-76.
[2] Granger, C. V., Hamilton, B. B., & Fiedler, R. C. (1995). The functional independence measure for children: a new tool for rehabilitation. Archives of Physical Medicine and Rehabilitation, 76(3), 279-284.
[3] Granger, C. V., & Hamilton, B. B. (1991). Validity of the functional independence measure. Archives of Physical Medicine and Rehabilitation, 72(6), 437-441.
[4] Granger, C. V., Hamilton, B. B., Linacre, J. M., Fiedler, R. C., & Wright, J. A. (1985). The functional independence measure: reliability and validity. Archives of Physical Medicine and Rehabilitation, 66(12), 822-827.
[5] Granger, C. V., Hamilton, B. B., & Fiedler, R. C. (1996). The functional independence measure for children: reliability and validity. Archives of Physical Medicine and Rehabilitation, 77(7), 719-724.