The Functional Independence Measure: A Measurement of Disability and Medical Rehabilitation
Measuring outcomes in medical rehabilitation must begin with an understanding of what is to be measured, and this understanding must be grounded in theory and connected to a comprehensive model for meeting the needs of the patient. Measurement tools for outcomes must then be designed and tested with respect to their purpose, practicality, construction, standardization, reliability, and validity. This chapter proposes a conceptual model called Challenges to the Quality of Daily Living that is based on the work of Abraham Maslow. The model describes the goal of fulfillment as achieving a balance between one’s choices, options, and expectations on the one hand (functional opportunities), with one’s physical, cognitive, and emotional constraints (functional demands/barriers) on the other. While these opportunities and demands are not directly measurable in qualitative or quantitative terms, the underlying factors supporting or forming barriers to health and function are measurable. The Functional Independence Measure (FIM) and the Uniform Data System for Medical Rehabilitation (UDSmr) are examined from the perspectives described above, and are found to provide practical measurement for patients undergoing medical rehabilitation for conditions that render them dependent on others for assistance in activities of daily living. The FIM has been shown to be reliable, valid, feasible, practical, and sensitive to clinical change in functional independence at admission, discharge, and follow-up. Use of the FIM and the UDSmr characterizes disability and change in severity through the use of a uniform language, and has important implications for national and international exchange of comparable information concerning outcomes.
KeywordsFunctional Independence Measure Arch Phys Medical Rehabilitation Functional Independence Measure Score Functional Status Scale
Unable to display preview. Download preview PDF.
- 3.Guide for the Uniform Data Set for Medical Rehabilitation (Adult FIMTM) version 4.0. (1993) State University of New York at Buffalo, Buffalo, NYGoogle Scholar
- 4.Nagi SZ (1965) Disability and rehabilitation. Ohio State University Press, ColumbusGoogle Scholar
- 5.World Health Organization (1980) International classification of impairments, disabilities, and handicaps: A manual of classification relating to the consequences of disease (ICIDH). World Health Organization, GenevaGoogle Scholar
- 6.Maslow AH (1954) Motivation and personality. Harper and Row, New YorkGoogle Scholar
- 7.von Bertalanffy L (1968) General system theory; foundations, development, applications. Braziller, New YorkGoogle Scholar
- 8.Kielhofher G, Burke JP (1980) A model of human occupation, Part 1. Conceptual framework and content. Am J Occup Ther 34:572–581Google Scholar
- 11.Hamilton BB, Granger CV, Sherwin FS, Zielezny M, Tashman JS (1987) A uniform national data system for medical rehabilitation. In: Fuhrer MJ (ed) Rehabilitation outcomes: analysis and measurement. Brookes, Baltimore, pp 137–147Google Scholar
- 13.Heinemann AW, Hamilton BB, Granger CV, Linacre JM, Wright BD (1992) Rehabilitation efficacy for brain and spinal cord injury—final report. Project R49/CCR503609. Rehabilitation Institute of Chicago, Centers for Disease Control, ChicagoGoogle Scholar
- 15.Stineman MG, Escarce JJ, Goin JE, Hamilton BB, Granger CV, Williams SV (1992) Function related groups (FRGs): a patient classification system for medical rehabilitation (abstract). Arch Phys Med Rehabil 73:957Google Scholar
- 16.Hamilton BB, Fiedler RC, Laughlin JA, Granger CV (1994) Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehab Med 26:115–119Google Scholar
- 23.Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger CV (1994) Measurement characteristics of the Functional Independence Measure (FIM). Top Stroke Rehabil 1:1–15Google Scholar