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Functional Independence Measure - Cognition Subscale (Cog-FIM)
Availability
The FIM is proprietary. For further information about obtaining the scale, syllabus, and training materials please contact:
    Uniform Data System for Medical Rehabilitation
    270 Northpointe Parkway, Suite 300
    Amherst, New York 14228
    (716) 817-7800 FAX (716) 568-0037
Classification
Basic for: Acute/Hospitalized and Moderate/ Severe Rehabilitation Traumatic Brain Injury
Supplemental for: Concussion/Mild TBI and Epidemiology TBI
Short Description of Instrument
The FIM is an 18-item ordinal scale, used with all diagnoses within a rehabilitation population. Items ars grouped into two subscales: Motor and Cognitive. The FIM measures degree of independence in activities of self-care, sphincter control, transfers, locomotion, communication, and cognition.
 
FIM was originally an acronym for "Functional Independence Measure". It is still often cited as this in the literature. The current owners of the FIM instrument have decided that the acronym FIM no longer stands for anything and should be referred to only as FIM.
 
The Cognitive Subscale consists of 5 items:
Comprehension
Expression
Social interaction
Problem solving
Memory
 
May be completed by rehabilitation clinicians as an observational scale, or by trained paraprofessionals or family members. May be administered by trained interviewers as a self report or proxy report instrument, in person or by phone. FIM(TM) certification is available and required to officially utilize the tool. A detailed manual guides scoring, based on operationally-defined functional abilities. Administration time is 10-20 minutes.
Scoring
FIM scores range from 1 (total or >75% assistance) to 7 (complete independence). Total score range= 18-126. Five item Cognitive subscore ranges from 5-35. Scores may be used raw or converted to interval scores. Higher scores indicate greater independence.
Psychometric Properties
Inter-rater reliability was found to be high for the total score and moderate to substantial for items assessing physical disability, except for the item concerned with assessing independence in walking or in wheelchair. The inter-rater agreement of FIM items in the communication and social cognition subsections was only fair. The internal consistency of the FIM assessment scale was found to be high.
 
Most appropriate for Severe and Moderate Disability levels of GOSE; ceiling effects limit utility in Good Recovery. Not sufficiently sensitive for mild TBI.
References
Uniform Data System for Medical Rehabilitation. 2009. The FIM System® Clinical Guide, Version 5.2. Buffalo: UDSMR.
 
Granger CV. The emerging science of functional assessment: our tool for outcomes analysis. Arch Phys Med Rehabil 1998;79(3):235-240.
 
Keith, R. A., Granger, C. V., et al. (1987). "The functional independence measure: a new tool for rehabilitation." Adv Clin Rehabil 1(3503663): 6-18.
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