The Functional Independence Measure: Tests of scaling, assumptions, structure, and reliability across 20 diverse impairment categories

Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, Philadelphia, USA.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 12/1996; 77(11):1101-8. DOI: 10.1016/S0003-9993(96)90130-6
Source: PubMed


The analysis presented here evaluated the psychometric properties of the Functional Independence Measure (FIM) as a summated rating scale within context of the 20 impairment categories of the FIM-Function Related Group (FIM-FRG) system.
This study involved a cross-sectional analysis of patient records, utilizing factor analysis and techniques of multitrait scaling to verify the summative properties of the motor and cognitive dimensions of the FIM and to study the statistical properties of admission FIM scores.
Included were a total of 93.829 patients discharged from 252 freestanding rehabilitation hospitals and units during calendar year 1992. Cases were excluded that had missing or out-of-range values or atypical lengths of stay. These criteria were developed previously in conjunction with an expert clinical panel and confirmed through statistical analyses.
Factor analyses supported the motor and cognitive dimensions across all 20 impairment categories. The resulting subscales exceeded minimum criteria for item internal consistency in 96.9% of tests and item discriminant validity in 100% of tests. Reliability coefficients for each impairment category for both subscales ranged from .86 to .97. There were no major ceiling effects, but patients in certain impairment categories were unable to climb stairs at admission.
The psychometric properties of the summated FIM compare favorably to most standardized health measures used in medical practice. Findings provide support for the motor and cognitive subscales as used in the FIM-FRGs. As a unidimensional scale, the FIM quantifies care burden. Split into the motor and cognitive (as used in the FIM-FRGs) it distinguishes physical disabilities from those arising from communication or cognitive difficulties.

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    • "It uses a score sum of 1 to 7 according to the degree of help. The minimum score is 18, and the maximum is 126 score24). In stroke patients, a higher level of stimulus is needed on the affected side than the unaffected side because type I and IIa muscle fibers and muscle fiber capillaries are damaged, and the activities of contractile proteins such as myofibrillar ATPase and succinate dehydrogenase are decreased. "
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    ABSTRACT: [Purpose] This study investigated the effect of functional electrical stimulation (FES) of stroke patients in a sitting position on balance and activities of daily living. [Methods] FES was applied to stroke patients (six male, three female) while in a sitting and supine position. FES was applied six times for 30 minutes each for a total of six weeks. [Results] The timed up and go (TUG) values at weeks 2, 4, and 6 after FES treatment in a sitting position were noticeably decreased in a time-dependent manner, compared with controls. In the sitting, the functional reach test (FRT) values were significantly increased in a time-dependent manner. The same values in the supine position weakly showed a similar pattern to those in the sitting position. Furthermore, the functional independent measurement (FIM) values in the sitting position were markedly increased in a time-dependent manner. In the sitting position, the intensity of FES was markedly decreased in a time-dependent manner. The same values in the supine position weakly showed a similar pattern to those in the sitting position. [Conclusion] These results suggest that the conditions of stroke patients in both the sitting and supine positions after FES treatment were improved and that FES had a greater effect in the sitting position.
    Journal of Physical Therapy Science 09/2013; 25(9):1097-1101. DOI:10.1589/jpts.25.1097 · 0.39 Impact Factor
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    • "Referred to as the FIM ™ scale (Dodds, Martin, Stolov, & Deyo, 1993; Hamilton, Laughlin, Fiedler, & Granger, 1994) (FIM) this clinical assessment enables uniform assessment of patients with a variety of cognitive or motor deficits. In a study of the reliability and validity of the FIM for evaluating impairment at the point of discharge from inpatient rehabilitation (Stineman et al., 1996) factor analysis of the motor and cognitive dimensions of the FIM returned reliability coefficients of .86 to .97, with no major ceiling effects. A subsequent study of 149 inpatients receiving neurorehabilitation (Hobart et al., 2001) reported that the FIM is a reliable and valid measure of disability in this population, comparable in psychometric properties to the longer 30 item FIM + Functional Assessment Measure. "
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    ABSTRACT: Interactive arts technologies, designed to augment the acute neurorehabilitation provided by expert therapists, may overcome existing barriers of access for patients with low motor and cognitive function. Develop an application prototype to present movement feedback interactively and creatively. Evaluate feasibility of use within acute neurorehabilitation. Record demographics and Functional Independent Measure™ scores among inpatients who used the technology during physical, occupational or recreational therapy. Record exercises performed with the technology, longest exercise duration performed (calculated from sensor data), user feedback, and therapist responses to a validated technology assessment questionnaire. Inpatients (n = 21) between the ages of 19 and 86 (mean 57 ± 18; 12 male/9 female) receiving treatment for motor deficits associated with neuropathology used the application in conjunction with occupational, recreational, or physical therapy during 1 to 7 sessions. Patients classified on the Functional Independence Measure™ as requiring 75%+ assistance for cognitive and motor function were able to use the interactive application. Customized interactive arts applications are appropriate for further study as a therapeutic modality. In addition to providing interactivity to individuals with low motor function, interactive arts applications might serve to augment activity-based medicine among inpatients with low problem-solving and memory function.
    Neurorehabilitation 08/2013; 33(3). DOI:10.3233/NRE-130981 · 1.12 Impact Factor
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    • "Level of disability at discharge from the acute care/rehabilitation facility was assessed with the Functional Independence Measure (FIM Keith et al., 1987). 2 The 18 items that comprise the FIM cover a wide range of abilities (e.g., problem-solving) and tasks (e.g., dressing) related to functional impairment. The FIM has been shown in prior research to be a valid and reliable indicator of degree of impairment across various patient groups, including those receiving rehabilitation following stroke (e.g., Ottenbacher, Hsu, Granger, & Fiedler, 1996; Stineman et al., 1996; Turner- Stokes, Williams, Rose, Harris, & Jackson, 2010), and it is mandated for stroke patients in Ontario. Mean FIM at discharge in the present study was 112.4 (SD ϭ 14.0; range: 59 to 126), which is comparable to at least one other large Canadian sample of stroke patients assessed at discharge (Passalent, Tyas, Jaglal, & Cott, 2011). "
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    ABSTRACT: Objectives: Assessment of adaptation following stroke has tended to focus either on acceptance of disability or global indicators of well-being. People with stroke, however, tend to view adaptation in terms of reengagement with personally valued activities. We model the adaptation process by assessing change in importance, control, stress, challenge, pleasure, support and self-identification of personal projects (i.e., one's current activities such as work, leisure, and recreational activities) from prestroke to 24 months poststroke. Method: Personal projects, general health, and general well-being were assessed via interviews with a sample of 67 community-residing stroke survivors (39 male; mean age = 64.7 years, SD = 13.2) on five occasions over the first 24 months poststroke. Results: Multilevel (hierarchical) modeling of the longitudinal data indicates that project dimensions of Control, Stress, Challenge, Pleasure, and Support predict well-being in expected ways. Although projects at 6 months poststroke were rated as more important, stressful, challenging, and supported by others and less controllable and pleasurable than prestroke projects, by 12 to 18 months all project ratings had returned to prestroke levels, thereby suggesting successful adaptation. Conclusions/implications: Longitudinal analysis of survivors' participation in valued activities poststroke revealed a pattern of adaptation that relates to but goes beyond that suggested by global measures of health, functioning, and well-being. The focus on adaptation of personal projects or valued activities may provide a helpful way of examining and improving well-being poststroke and offer new insights to inform the development of effective interventions for improving well-being following stroke. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Rehabilitation Psychology 07/2013; 58(3). DOI:10.1037/a0033400 · 1.91 Impact Factor
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