Original Citation - Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6-18. View in PubMed 

Price & Availability - Click here to view the instrument on StrokeEngine's website and the user's manual on the Department of Vetrans Affairs website.

 Brief Description of Instrument - Uniform system of measurement for disability based on the International Classification of Impairment, Disabilities and Handicaps. The level of a patient's disability indicates the burden of care. 

Administration Time - 30 - 45 minutes. 

Scale Format - Short answer.  18 items. 

Administration Technique - Health provider administered via interview with patient or proxy.

Scoring and Interpretation - Items are scored based upon the level of assistance required for activities of daily living.  Range: Level 7 Complete Independence - Level 1 Total Assist. 

Factors and Norms - Six areas of function (self-care, sphincter control, mobility, locomotion, communication and social cognition), which fall under two dimensions (motor and cognitive). 

Test-retest Reliability - Intraclass correlation (ICC) 0.93 reported for total FIM in rehabilitation patients under 20 years old.  In other studies, the total FIM a correlation (r) of 0.83-0.95 was reported. Please see StrokeEngine Website for more details. 

Inter-rater Reliability - Reported ICC ranges from 0.62-0.99.  Low kappa statistic also reported 0.21-0.40.  Please see StrokeEngine Website for more details. 

Internal Consistency - Cronbach's alpha 0.93 for admissions and 0.95 for discharges. 

Construct Validity - Discriminant validity found for groups based on spinal cord injury, stroke severity, presence of comorbid illness, neglect and aphasia. 

Criterion-Related Validity - Correlations found with Barthel Index, Modified Rankin Scale and Disability Rating Scale. Predictive validity found for: amount of home care required; placement after discharge; functional gain; length of stay, depression and ability to return to work. Please see StrokeEngine Website for more details.  For predictive validity, please see Timbeck & Spaulding (2003) paper noted in Related Methods Articles. 

Responsive to Change Over Time - Small effect sizes reported in patients with multiple sclerosis and large effect sizes in patients with stroke.   Please see StrokeEngine Website for details. 

Content & Face Validity - Item development based on literature review and review of similar scales.  Reviewed by expert panels for validity, refined through pilot testing in 11 centers. 

Strengths - Widely used, documented reliability and validity.   

Notes for Consideration - It has been tested for use in patients with stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, elderly individuals undergoing inpatient rehabilitation and with children. Tool is available in a variety of languages.  Significant costs can be associated with training required for tool administration. 

Published APN Studies Using Instrument - Poduri KR, Palenski C, Gibson CJ. Inpatient rehabilitation: physiatrist and nurse practitioner admission assessment of stroke patients and their rehabilitation outcomes.  Int J Rehabil Res. 1996 Jun;19(2):111-21. View in PubMed

Related Methods Articles (Not Reviewed) - Stroke Engine, FIM Psychometric Properties
Timbeck, R. J., Spaulding, S. J. (2003). Ability of the Functional Independence Measure to predict rehabilitation outcomes after stroke: A review of the literature. Physical & Occupational Therapy in Geriatrics, 22(1), 63-76.