The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories.
ABSTRACT 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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ABSTRACT: Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge. Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home. The sample included 148 367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r(2)=0.107). No important additional effect for any other variable was detected when added to this model. This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set. © 2015 American Heart Association, Inc.Stroke 02/2015; 46(4). DOI:10.1161/STROKEAHA.114.007392 · 6.02 Impact Factor
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ABSTRACT: Objective: To identify the predictors of community participation after spinal cord injury. Design: Cross-sectional design. Methods: A total of 139 persons with spinal cord injury living in the community completed 4 instruments: the Impact on Participation and Autonomy (IPA-Thai version), the Craig Hospital Inventory of Environmental Factors (CHIEF-SF-Thai version), the Personal Resource Questionnaire (PRQ2000-Thai version), and a personal history questionnaire. Functional performance was assessed using the Functional Independence Measure (FIM) motor subscale. Results: Participants comprised 79% males. Fifty-one percent of variance in community participation was explained by social support, functional performance, age, and age at time of injury. Conclusion: Key predictors of community participation were the availability of social support and the individual's functional performance. These predictors should be emphasized when developing interventions in rehabilitation and community settings.Journal of Rehabilitation Medicine 01/2015; 47(4). DOI:10.2340/16501977-1932 · 1.90 Impact Factor
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ABSTRACT: Background: The University Rehabilitation Institute in Ljubljana provides comprehensive rehabilitation for the whole territory of Slovenia. The aim of the study was to verify a clinical observation that the demandingness of rehabilitation has been increasing because of a decrease in patients' functional abilitites on admission, with rehabilitation outcomes having remained unchanged or even improved. Methods: Functional Independence Measure (FIM) scores of 651 cerebrovascular insult (CVI) and 151 multiple sclerosis (MS) patients gathered between September 2004 and September 2006 (all eligible cases) were compared with those for patients with the same diagnosis (N=144 and 74, respectively) collected during the period from September 1999 to September 2000 (a random sample), considering only first-admission cases. The average FIM (motor, cognitive and total) scores and FIM gain after rehabilitation during the two periods were determined for each diagnostic group adjusted for patient age. Rehabilitation efficiency and effectiveness levels were compared in the same way. Effect Size and Standardised Response Mean were also analysed. Results: There were no differences in gender structure of the groups between the periods studied. During the recent period, the average age was higher by around two years in both groups. The length of stay was marginally shortened for CVI patients and remained unchanged for MS patients. There were no differences between the two periods concerning the time elapsed since stroke. In both groups, admission motor and cognitive FIM scores were on average approximately five points lower in the recent period, while the average rehabilitation gain from admission to discharge increased over time (in total by 1 in CVI patients and by 3 in MS patients). Regarding motor and total FIM scores, the standardised gain, rehabilitation efficiency and rehabilitation effectiveness increased as well. Conclusions: The Institute is admitting more severely affected patients than it did five to ten years ago, and parallelly the patient age has increased. Despite that and notwithstanding the tendency towards shorter rehabilitation, expected age-adjusted functional independence gain, rehabilitation efficiency, rehabilitation effectiveness, and the standardised functional independence gain have increased.01/2011; 50(1). DOI:10.2478/v10152-010-0025-6