Article
A validation of the Functional Independence Measurement and its performance among rehabilitation inpatients,☆☆

https://doi.org/10.1016/0003-9993(93)90119-UGet rights and content

Abstract

The Functional Independence Measurement (FIM) is a new functional status instrument for use among rehabilitation inpatients, but its validity and reliability have been only partially established. Because of its rapid dissemination, we sought further evidence concerning the FIM's internal consistency, responsiveness over time, and construct validity. We examined Uniform Data System (UDS) data on 11,102 general rehabilitation inpatients from the Pacific Northwest. Mean age was 65 and 51% were male. The most common diagnoses were stroke (52%), orthopedic conditions (10%), and brain injury (10%). Internal consistency of the FIM was calculated using Cronbach's α. To assess FIM responsiveness, we examined differences between admission and discharge FIM scores. For construct validation purposes, we hypothesized that the FIM would vary with age, comorbidity, discharge destination, and impairment severity. Comorbidity was quantified with the Charlson Comorbidity Index. The FIM had a high overall internal consistency (discharge FIM α = .93). The FIM registered significant functional gains during rehabilitation (33% FIM score improvement, p < .001), as do many other functional status indicators. The greatest and least functional improvements were observed for traumatic brain injury and low back pain (53% and 8% FIM score improvement, respectively). The FIM discriminates patients on the basis of age, comorbidity, and discharge destination. Severity differences could be distinguished among spinal cord injury and stroke patients. We conclude that the FIM has high internal consistency and adequate discriminative capabilities for rehabilitation patients. It is a good indicator of burden of care, and demonstrates some responsiveness, but its capacity to measure change over time needs further examination and comparison with competing scales.

References (26)

  • GN Davidoff et al.

    Cognitive dysfunction in spinal cord injury patients: sensitivity of the Functional Independence Measurement Subscales vs neuropsychologic assessment

    Arch Phys Med Rehabil

    (1990)
  • S Hosek et al.

    Charges and outcomes for rehabilitative care: implications for the prospective payment system

    (1986)
  • MV Johnston et al.

    Cost-effectiveness of the Medicare Three-hour Regulation

    Arch Phys Med Rehabil

    (1986)
  • Cited by (0)

    This research was supported by the Robert Wood Johnson Clinical Scholars Program and the Department of Veterans Affairs, Health Services Research and Development Field Program. Seattle, WA (grant IIR 91-127R).

    Data provided by the Northwest Association of Rehabilitation Facilities.

    ☆☆

    The opinions and conclusions in this article are those of the authors and do not necessarily represent the views of the RWJ Clinical Scholars Program, the Veterans Administration, the University of Washington, or the Northwest Association of Rehabilitation Facilities.

    View full text