Use of the Functional Independence Measure for Outcomes Measurement in Acute Inpatient Rehabilitation

Abstract

Assessment of functional status is a major responsibility for professionals practicing in rehabilitation facilities. Functional assessment tools have been created to meet this need. One of the most widely used tools is the Functional Independence Measure (FIM). Data from the FIM are used to examine patient outcomes for several purposes. This article explores the rationale for use of the FIM as an outcomes measure and research regarding the validity, reliability, responsiveness, and utility of this tool. Limitations of this instrument, future research needs, and implications for rehabilitation professionals also are discussed.

A daily adjustable progressive resistance exercise protocol and functional training to increase quadriceps muscle strength and functional performance in an elderly homebound patient following a total knee arthroplasty

“…The FIM is recognized as the rehabilitation industry's most reliable [kappa coefficient for the total FIM was 0.91 (95% CI, 0.82-1.0)], valid, and responsive functional assessment tool. The ability of the instrument to detect meaningful change in the level of function during rehabilitation has been observed to be high (Cournan, 2011). The FIM demonstrated acceptable reliability across a wide variety of settings, raters, and patients (Ottenbacher, Hsu, Granger, and Fielder, 1996).…”

“…(2) sphincter control (2 items); (3) mobility (3 items); (4) locomotion (3 items); (5) communication (2 items); (6) social adjustment/cooperation (4 items); and (7) cognition/problem solving (3 items) (Cournan, 2011;Ottenbacher, Hsu, Granger, and Fiedler, 1996). The FIM is recognized as the rehabilitation industry's most reliable [kappa coefficient for the total FIM was 0.91 (95% CI, 0.82-1.0)], valid, and responsive functional assessment tool.…”

Development of Professionalism and Performance Accountability for Sustained FIM Accuracy Improvement

“…Based on a patient's age, rehabilitation impairment category, admission FIM motor score, and in some cases, considering the FIM cognition scores, a case mix group (CMG) is assigned to that particular patient, which in turns provides a payment amount and length of stay determination, as determined by CMS. Cournan (2011) explored the rationale for FIM assessment and identified tool limitations including: consideration of the number of patients with specific diagnoses when interfacility comparisons are made; shifting of tool purpose over time; need for considerable training for optimum interrater reliability; lack of uniform education programs or competency exams; and lack of standardization reducing ability to compare results between facilities. Bush (2008) discovered that documentation errors found by recovery audit contractors (RACs) have resulted in denied claims for IRFs and hospitals across the country.…”

“…For example, a patient requiring one person mobility assistance has a higher burden of care than a patient who is independent with use of a device. The FIM scoring tool has been repeatedly validated in research (Cournan, 2011). FIM scoring accuracy is essential for placement in the correct impairment and casemix groupings, which are used to estimate length of stay and reimbursement.…”

A comparison of stroke rehabilitation; data from two national cohorts

“…Basic medical (type of stroke diagnosis and side of lesion in the brain), and sociodemographic information (age and gender), as well as organizational aspects of rehabilitation [time since onset of stroke (weeks) until rehabilitation and length of inpatient rehabilitation (days)], was used to describe both populations. The Functional Independence Measure (FIM) (17,18), which assess dependency in activities of daily living, was used as an outcome variable in this study. It is used as a routine assessment tool, for functioning levels at the beginning of rehabilitation and at discharge in Latvia and Sweden.…”