Functional Independence Measure (FIM)

Objective

The Functional Independence Measure (FIM) is an 18-item measurement tool that explores an individual's physical, psychological and social function. This is par of Uniform Data System for Medical Rehabilitation (UDSMR)[1] 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.[1][2] The FIM uses the level of assistance an individual needs to grade functional status from total independence to total assistance

Intended Population

Patients with functional mobility impairments.

Method of Use

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. FIM scores range from 1 to 7. The grading categories range from "total assistance with helper = 1" to "complete independence with no helper=7". Irrespective of the use of any assistive device, the person is considered complete independence. Scores falling below 6 require another person for supervision or assistance.

Tasks that are evaluated using the FIM include bowel and bladder control, transfers, locomotion, communication, social cognition as well as the following six self-care activities:[1][1] [2]

  • Feeding
  • Grooming
  • Bathing
  • Upper Body Dressing
  • Lower Body Dressing
  • Toileting

The FIM measures what an individual can perform and not what that person could do under certain circumstances.

Functional Independence Measure.jpg

FIM Levels[1]


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.



Reliability

Inter-Rater Reliability of FIM has been established at an acceptable psychometric performance (Intraclass co-relation coefficients ranging from 0.86 to 0.88)

Validity

The concurrent validity with Barthel Index (ICC > 0.83), Gosman-Hedstrom and Svenson have shown strong construct validity between items on Barthel Index and items on the FIM the measure functional limitations[3]


References

  1. 1.0 1.1 1.2 1.3 1.4 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.
  2. 2.0 2.1 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.
  3. Gosman-Hedstrom, G, and Svensson, E: Parallel reliability of the Functional Independence Measure and the Barthel index ADLIndex. Psychiatry 73:188, 2000