The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation following a Stroke from the National UK Clinical Dataset

Abstract

The UK Functional Assessment Measure (UKFIM+FAM) is the principal outcome measure for the UK Rehabilitation Outcomes Collaborative (UKROC) national database for specialist rehabilitation. Previously validated in a mixed neurorehabilitation cohort, this study is the first to explore its psychometric properties in a stroke population, and compare left and right hemispheric strokes (LHS vs RHS). We analysed in-patient episode data from 62 specialist rehabilitation units collated through the UKROC database 2010–2013. Complete data were analysed for 1,539 stroke patients (LHS: 588, RHS: 566 with clear localisation). For factor analysis, admission and discharge data were pooled and randomised into two equivalent samples; the first for exploratory factor analysis (EFA) using principal components analysis, and the second for confirmatory factor analysis (CFA). Responsiveness for each subject (change from admission to discharge) was examined using paired t-tests and differences between LHS and RHS for the entire group were examined using non-paired t-tests. EFA showed a strong general factor accounting for >48% of the total variance. A three-factor solution comprising motor, communication and psychosocial subscales, accounting for >69% total variance, provided acceptable fit statistics on CFA (Root Mean Square Error of Approximation was 0.08 and Comparative Fit Index/ Tucker Lewis Index 0.922/0.907). All three subscales showed significant improvement between admission and discharge (p<0.001) with moderate effect sizes (>0.5). Total scores between LHS and RHS were not significantly different. However, LHS showed significantly higher motor scores (Mean 5.7, 95%CI 2.7, 8.6 p<0.001), while LHS had significantly lower cognitive scores, primarily in the communication domain (-6.8 95%CI -7.7, -5.8 p<0.001). To conclude, the UK FIM+FAM has a three-factor structure in stroke, similar to the general neurorehabilitation population. It is responsive to change during in-patient rehabilitation, and distinguishes between LHS and RHS. This tool extends stroke outcome measurement beyond physical disability to include cognitive, communication and psychosocial function.

Rasch analysis of the UK Functional Assessment Measure in a sample of patients with traumatic brain injury from the UK national clinical database

“…We extracted the cohort of all 1,956 TBI patients consecutively admitted to the 58 Level 1 and 2 specialist neurorehabilitation centres that submitted data to the UKROC database between 1 January 2010 and 30 May 2016, for whom a UK FIM+FAM score was available both at admission and discharge from the rehabilitation programme. A similar process for data extraction and analysis was used to that in the previous publications for stroke (12,17), as summarized in Fig. 1.…”

“…Traditional psychometric evaluations of the UK FIM+FAM in both a general neuro-rehabilitation cohort and in stroke patients (12,13) have shown the UK FIM+FAM to have 3 distinct subscales: Motor, Communicative, and Psychosocial. Two studies from the 1990s have explored the linear Rasch transformation of the original US FIM+FAM scale following TBI and showed partial conformation to the Rasch model (14,15).…”

Persian Translation, Internal Consistency and Reliability of Wolf Motor Function Test

“…Although some tools relating to disability, general health and patient satisfaction may be used in assessing upper extremity recovery, functional assessment is the key in the assessment of outcome of treatment provided to improve the daily activity of upper extremities in stroke patients [3,4].…”

A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models

“…Patients with moderate to severe acquired brain injury (ABI) may experience long-lasting or permanent difficulties with mobility, activities of daily living, cognition and social reintegration 1 . Accurate functional assessments enable interdisciplinary teams to set meaningful rehabilitation goals, make better predictions about prognosis, and identify appropriate discharge placements earlier in rehabilitation 2,3 .…”

“…It evaluates functional impairment and assistance needs across physical, communication and psychosocial domains, using input from the interdisciplinary therapeutic team. The FIM+FAM is a reliable, valid scale with high internal consistency, excellent test-retest reliability and very good inter-rater reliability, and is one of the most widely-used outcome measures in ABI rehabilitation 2,[4][5][6][7] . However, conflicting arguments have been advanced regarding the structure of the FIM+FAM, affecting its interpretation and prognostic utility.…”