BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet
Test: Functional Independence Measure (FIM)
Assessment Tool Category: Caregiver
Variations/Translations: Variations include the WEE-FIM (children), and the Modified 5-Level FIM. The FIM has been translated into a number of languages including French, German, Japanese, and Swedish.
Setting: Clinical, rehabilitation, or in-patient
Method of Delivery: Patient interview and evaluation/observation by a trained interviewer.
Description: The FIM assesses the severity of physical and cognitive disability among rehabilitation patients in terms of burden of care. It includes 18 items across 6 domains: self care, sphincter control, mobility, locomotion, communication, and social cognition. The physical items of the scale were based on the Barthel Index. The assessment is based on actual performance, rather than hypothetical capacity to complete a task (McDowell & Newell, 1996).
Scoring/Interpretation: Total scores range from 18-126. Each item is scored on a scale of 1 to 7; levels 1-2 indicate total dependence, levels 3-5 modified dependence, and levels 6-7 independence. Scores for each item are added to give an overall score. The higher the score, the greater the patient’s functional abilities. Alternative scoring approaches are available (McDowell & Newell, 1996).
Time to Administer: 30 minutes
Availability: Available from the Uniform Data System for Medical Rehabilitation (see website below).
Validity (Quantitative): Content validity was assessed during development of the FIM by clinicians and modified according to their suggestions. The FIM was evaluated for its predictive validity and was found to accurately predict the amount of time needed to care for a patient (excluding cases of visual impairment) (R2 = 0.99). Similar calculations were made for a group of stroke patients, and the R2 value was reported to be 0.65 (McDowell & Newell, 1996). Construct validity was assessed by examining the FIM scores of 11,102 patients upon their entering and leaving a rehabilitation facility. Results showed that there was significant discrimination between admission and discharge, in the expected direction (p < 0.001) (Dodds, Martin, Stolov, & Deyo, 1993). Moderate to high concurrent validity of the FIM with other measures has been reported, including correlation with the Barthel Index (0.84), Katz’s Index of ADL (0.68), and Spitzer’s Quality of Life Index (0.45) (McDowell & Newell, 1996).
Reliability (Quantitative): Inter-rater reliability tests demonstrated high intraclass correlation coefficients (mean of 0.92 over eleven studies) (McDowell & Newell, 1996).
Keith, R.A., Granger, C.V., Hamilton, B.B., & Sherwin, F.S. (1987). The functional independence measure: a new tool for rehabilitation. Advances in Clinical Rehabilitation, 1, 6-18.
McDowell, I., & Newell, C. (1996). Measuring Health: A Guide to Rating Scales and Questionnaires (2nd ed). New York: Oxford University Press.
Ottenbacher, K.J., Hsu, Y., Granger, C.V., and Fielder, R.C. (1996). The Reliability of the Functional Independence Measure: A Quantitative Review. Archives of Physical Medicine and Rehabilitation, 77(12), 1226-1232.
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