Functional Independence Measure (FIM)

Objective[edit | edit source]

PP Disability Images.jpg

The Functional Independence Measure (FIM) is an instrument that was developed as a measure of disability for a variety of populations and is not specific to any diagnosis. The FIM instrument

  • Includes measures of independence for self-care, including sphincter control, transfers, locomotion, communication, and social cognition[1].
  • Is an 18-item, seven-level, ordinal scale intended to be sensitive to changes over the course of a comprehensive inpatient medical rehabilitation program.
  • Uses the level of assistance an individual needs to grade functional status from total independence to total assistance).
  • The tool is used to assess a patient's level of disability as well as a change in patient status in response to rehabilitation or medical intervention.[2][3]

Intended Population[edit | edit source]

Designed to assess areas of dysfunction in activities that commonly occur in subjects with any progressive, reversible or stable neurologic, musculoskeletal, or other disorder ie patients with functional mobility impairments[4].

The FIM is used by healthcare practitioners to assess and grade the functional status of a person based on the level of assistance he or she requires.

Method of Use[edit | edit source]

Guide for use: Patient function is assessed using the FIM™ instrument at the start of a rehabilitation episode of care and at the end of a rehabilitation episode of care. Admission assessment is collected within 72 hours of the start of a rehabilitation episode. Discharge assessment is collected within 72 hours prior to the end of a rehabilitation episode.

FIM™ is comprised of 18 items, grouped into 2 subscales - motor and cognition.

The motor subscale includes:

  • Eating
  • Grooming
  • Bathing
  • Dressing, upper body
  • Dressing, lower body
  • Toileting
  • Bladder management
  • Bowel management
  • Transfers - bed/chair/wheelchair
  • Transfers - toilet
  • Transfers - bath/shower
  • Walk/wheelchair
  • Stairs

The cognition subscale includes:

  • Comprehension
  • Expression
  • Social interaction
  • Problem solving
  • Memory

Each item is scored on a 7 point ordinal scale, ranging from a score of 1 to a score of 7. The higher the score, the more independent the patient is in performing the task associated with that item.[5]

FIM levels

No Helper

  • 7. Complete Independence  (Timely, Safety)
  • 6. Modified Independence (Device)

Helper - Modified Dependence

  • 5. Supervision (Subject = 100%)
  • 4. Minimal Assistance (Subject = 75% or more)
  • 3. Moderate Assistance (Subject = 50% or more)

Helper - Complete Dependence

  • 2. Maximal Assistance (Subject = 25% or more)
  • 1. Total Assistance or not Testable (Subject less than 25%)

Leave no blanks. Enter 1 if not testable due to risk.[2]

The total score for the FIM

  • motor subscale (the sum of the individual motor subscale items) will be a value between 13 and 91.
  • cognition subscale (the sum of the individual cognition subscale items) will be a value between 5 and 35.

The total score for the FIM instrument (the sum of the motor and cognition subscale scores) will be a value between 18 and 126.[5]

Reliability and Validity[edit | edit source]

  1. Inter-Rater Reliability of FIM has been established at an acceptable psychometric performance (Intraclass co-relation coefficients ranging from 0.86 to 0.88)
  2. The concurrent validity with Barthel Index (ICC > 0.83) have shown strong construct validity between items on Barthel Index and items on the FIM the measure functional limitations[6]

References[edit | edit source]

  1. Cameron MH, Monroe L. Physical Rehabilitation-E-Book: Evidence-based examination, evaluation, and intervention. Elsevier Health Sciences; 2007 Apr 5.Available: 22.5.2021)
  2. 2.0 2.1 Linacre JM, Heinemann JW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil. 1994. 75: 127-132.
  3. Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993. 74: 566-573.
  4. Elia AE, Graziella F, Albanese A. 12 Clinical Trials of Botulinum Toxin in Adult Spasticity. Botulinum Toxin E-Book: Therapeutic Clinical Practice and Science. 2009 Feb 18:148.Available from: 22.5.2021)
  5. 5.0 5.1 AIHW FIM Available from: (accessed 22.5.20210
  6. Gosman-Hedstrom, G, and Svensson, E: Parallel reliability of the Functional Independence Measure and the Barthel index ADLIndex. Psychiatry 73:188, 2000