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Functional Independence Measure

Original Editor - Ajay Upadhyay

Top Contributors - Farah Al Dweik, Laura Ritchie, Gayatri Jadav Upadhyay, Ajay Upadhyay, Kim Jackson, Nikhil Benhur Abburi, Lucinda hampton, Momina Khalid, Oshomoji Olawale, Evan Thomas, WikiSysop, Vidya Acharya, Nicole Hills, Lauren Lopez, Kapil Narale and Alexandra Stead

Objective

The Functional Independence Measure (FIM) is an 18-item, seven-level ordinal scale used to assess a person’s level of disability and changes in functional status in response to therapeutic intervention.[1][2] It assesses self-care independence, sphincter control, transfers, locomotion, communication and social cognition.[2] Functional status is graded according to the level of assistance required, ranging from total assistance to complete independence.[2] The total score ranges from 18 to 126, with higher scores indicating greater independence.[1]

Intended Population

The FIM is used to assess functional independence across a range of adult rehabilitation populations. It has been used in people undergoing rehabilitation following stroke, traumatic brain injury and spinal cord injury, as well as in people with multiple sclerosis.[3][4][5][6]

For children, the Functional Independence Measure for Children (WeeFIM) is a paediatric measure modelled after the adult FIM. It assesses functional performance in children across self-care, sphincter control, transfers, locomotion, communication and social cognition.[7][8]

Measures

The FIM measures a person’s independence in performing everyday activities and the amount of assistance needed to complete them.[9]

Administration

The FIM is usually completed by members of the rehabilitation team. In inpatient rehabilitation, it is scored at admission and discharge based on the person’s functional performance.[10] FIM scores can also be collected through an interview when direct assessment is not possible.[10]

Time to Administer

The FIM takes approximately 30–45 minutes to administer and score.[11]

Method of Use

The FIM is completed using information about how the person performs the 18 activities in their usual rehabilitation setting.[3] Each item is considered separately, with the rating based on the assistance needed to complete the activity. The 18 items are divided into two subscales: motor (13 items) and cognition (5 items).[5][12][13]

Motor Subscale

The motor subscale includes 13 items across four areas: self-care, sphincter control, transfers and locomotion..[5][13]

Self Care

Six items are used to assess independence in self-care:

  • Eating
  • Grooming
  • Bathing
  • Dressing, upper body
  • Dressing, lower body
  • Toileting

Sphincter Control

Two items assess the level of assistance required for bladder and bowel management:

Transfers

Transfer ability is assessed across three activities:

  • Transfers - bed/chair/wheelchair
  • Transfers - toilet
  • Transfers - bath/shower

[14]

Locomotion

Two items are used to assess locomotion:

Cognition Subscale

The cognition subscale includes five items across communication and social cognition.[5][13]

Communication

Two items assess communication:

  • Comprehension
  • Expression

Social Cognition

hree items assess social cognition:

  • Social interaction
  • Problem solving
  • Memory

Scoring

Each FIM item is scored on a seven-point scale from 1 to 7, with higher scores indicating greater independence.[13][15] The individual item scores are added to give a total score ranging from 18 to 126.[13][15] The motor subscale ranges from 13 to 91, and the cognitive subscale ranges from 5 to 35.[13][15]

FIM Levels

FIM scores are grouped according to the amount of assistance a person requires to complete an activity.[13] The seven levels range from complete independence to total assistance.[13][16]

FIM Levels of Assistance[13][16]
Level Classification Description
7 Complete independence The person completes the activity safely, without assistance or an assistive device, and within a reasonable amount of time.
6 Modified independence The person completes the activity without assistance but requires an assistive device or more than a reasonable amount of time, or there are safety considerations.
5 Supervision or setup The person requires supervision, prompting or setup but no physical assistance.
4 Minimal assistance The person performs 75% or more of the activity.
3 Moderate assistance The person performs 50–74% of the activity.
2 Maximal assistance The person performs 25–49% of the activity.
1 Total assistance The person performs less than 25% of the activity or requires total assistance.

Translations

The FIM has been translated and cross-culturally adapted for use in different languages and populations. Published validated versions include Persian, Turkish and Brazilian Portuguese, among others.[17][18][19] Where available, a validated version appropriate to the language and population being assessed should be used.

Reliability and Validity

The FIM has demonstrated high reliability.[20] A quantitative review of 11 studies reported a median inter-rater reliability of 0.95 for the total FIM and a median test-retest reliability of 0.95.[20]

The structure of the FIM has also been examined using Rasch analysis.[2] Linacre et al. found that the 18 FIM items formed two statistically and clinically distinct domains: 13 motor items and five cognitive items.[2] These measures showed similar characteristics at admission and discharge, supporting their use to assess change in functional status.[2]

A later Rasch analysis revisited the internal construct validity of the 18-item FIM.[21] When local dependency was addressed by grouping items into two testlets, the 18 items showed fit to the Rasch model.[21] The authors concluded that the total FIM score could represent a unidimensional set of items when the appropriate transformation is applied.[21]

The FIM has also shown good concurrent validity with other measures of functional independence.[22] In people with stroke, the FIM motor subscale showed high agreement with both the 5-item and 10-item Barthel Index, with correlations of 0.92 or higher and intraclass correlation coefficients of 0.83 or higher.[22]

Responsiveness

The FIM is responsive to changes in functional status during rehabilitation. In people with stroke, the motor subscale demonstrated high responsiveness, with a standardised response mean of 1.3.[22] Responsiveness may vary between the motor and cognitive components and across rehabilitation populations.[23]

Summary

The FIM is an 18-item measure used to assess functional independence and the level of assistance a person requires in daily activities.[1] [2] It includes motor and cognitive components and is commonly used in rehabilitation to assess functional status and monitor change over time.[9] The FIM has demonstrated reliability, validity and responsiveness across different rehabilitation populations.[20][21][23]

References

  1. ↑ 1.0 1.1 1.2 Bouça-Machado R, Rosário A, Caldeira D, Castro Caldas A, Guerreiro D, Venturelli M, et al. Measurement tools to assess activities of daily living in patients with Parkinson’s disease: a systematic review. Front Neurosci. 2022;16:945398. doi:10.3389/fnins.2022.945398.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil. 1994;75(2):127-32.
  3. ↑ 3.0 3.1 Fukuda S, Yamamoto N, Tomita Y, Matsumoto T, Shinohara T, Ohno T, et al. Development and validation of clinical prediction model for functional independence measure following stroke rehabilitation. J Stroke Cerebrovasc Dis. 2025;34(2):108185
  4. ↑ Haddad R, Turmel N, Lagnau P, Chesnel C, Le Breton F, Amarenco G, et al. Functional independence measure predicts the outcome of clean intermittent catheterization training in patients with multiple sclerosis. Ann Phys Rehabil Med. 2022;65(2):101539.
  5. ↑ 5.0 5.1 5.2 5.3 Prodinger B, Ballert CS, Brinkhof MWG, Tennant A, Post MWM. A Rasch-based comparison of the Functional Independence Measure and Spinal Cord Independence Measure for outcome and quality in the rehabilitation of persons with spinal cord injury. J Rehabil Med. 2022;54:jrm00257.
  6. ↑ Tarvonen-Schröder S, Koivisto M. World Health Organization Disability Assessment Schedule versus Functional Independence Measure in traumatic brain injury. J Rehabil Med. 2023;55:jrm16274. doi:10.2340/jrm.v55.16274.
  7. ↑ Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Granger CV, Braun S. Interrater agreement and stability of the Functional Independence Measure for Children (WeeFIM): use in children with developmental disabilities. Arch Phys Med Rehabil. 1997;78(12):1309-15. doi:10.1016/S0003-9993(97)90302-6.
  8. ↑ Koçyiğit MF, El Ö, Akaltun MS, Öksüz Ç. Validity and reliability of the WeeFIM in children with cerebral palsy. Disabil Rehabil. 2022.
  9. ↑ 9.0 9.1 Bouça-Machado R, Rosário A, Caldeira D, Castro Caldas A, Guerreiro D, Venturelli M, et al. Measurement tools to assess activities of daily living in patients with Parkinson’s disease: a systematic review. Front Neurosci. 2022;16:945398. doi:10.3389/fnins.2022.945398.
  10. ↑ 10.0 10.1 Ring H, Feder M, Schwartz J, Samuels G. Functional measures of first-stroke rehabilitation inpatients: usefulness of the Functional Independence Measure total score with a clinical rationale. Arch Phys Med Rehabil. 1997;78(6):630-5.
  11. ↑ Shirley Ryan AbilityLab. Functional Independence Measure. Chicago: Shirley Ryan AbilityLab; [cited 2026 Aug 27].
  12. ↑ Schmidt J, et al. Rehabilitation outcomes after comprehensive post-acute inpatient rehabilitation following moderate to severe acquired brain injury—study protocol for an overall prognosis study based on routinely collected health data. Diagn Progn Res. 2024;8.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 Australian Institute of Health and Welfare. Functional Independence Measure. Canberra: Australian Institute of Health and Welfare; [cited 2026 Aug 25].
  14. ↑ Enable Lifecare. FIM Score Explained: Choosing the Best Hoist & Sling for Safe Transfers. Available from: https://www.youtube.com/watch?v=YUo5wc5iUBo [last accessed 1/9/2026]
  15. ↑ 15.0 15.1 15.2 Inoue Y, et al. Performance of a prediction method for activities of daily living scores using influence coefficients in patients with stroke. Front Neurol. 2024;15:1419405.
  16. ↑ 16.0 16.1 Shimizu T, Kanai C, Asakawa Y. Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: a retrospective case-control study. Physiother Res Int. 2024;29(1):e2070.
  17. ↑ Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant A. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil. 2001;15(3):311-9.
  18. ↑ Riberto M, Miyazaki MH, Jucá SSH, Sakamoto H, Pinto PPN, Battistella LR. Validation of the Brazilian version of Functional Independence Measure. Acta Fisiatr. 2004;11(2):72-6.
  19. ↑ Naghdi S, Ansari NN, Raji P, Shamili A, Amini M, Hasson S. Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke. Disabil Rehabil. 2016;38(3):289-98.
  20. ↑ 20.0 20.1 20.2 Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the Functional Independence Measure: a quantitative review. Arch Phys Med Rehabil. 1996;77(12):1226-32.
  21. ↑ 21.0 21.1 21.2 21.3 Maritz R, Tennant A, Fellinghauer C, Stucki G, Prodinger B. The Functional Independence Measure 18-item version can be reported as a unidimensional interval-scaled metric: internal construct validity revisited. J Rehabil Med. 2019;51(3):193-200.
  22. ↑ 22.0 22.1 22.2 Hsueh IP, Lin JH, Jeng JS, Hsieh CL. Comparison of the psychometric characteristics of the Functional Independence Measure, 5 item Barthel Index, and 10 item Barthel Index in patients with stroke. J Neurol Neurosurg Psychiatry. 2002;73(2):188-90.
  23. ↑ 23.0 23.1 van der Putten JJMF, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999;66(4):480-4.
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