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Functional Independence Measure - Cognition Subscale (Cog-FIM)
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:
Website: Please click here to find more information: Functional Independence Measure.
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| Classification |
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure of cognitive activity limitations in moderate-to-severe Traumatic Brain Injury (TBI) and other acquired brain injuries requiring rehabilitation.
Basic: Acute/Hospitalized and Moderate/ Severe Rehabilitation TBI
Supplemental: Concussion/Mild TBI and Epidemiology TBI
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| Short Description of Instrument |
The FIM is an 18-item ordinal scale, used with all diagnoses within a rehabilitation population. Items are 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".
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.
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| Comments/Special Instructions |
NeuroRehab Specific: The FIM is a widely used observational/self-report measure using objective criteria for scoring and therapist or patient/family observations. It is most appropriate for inpatient rehabilitation and during the first few years after injury or until the individual has regained independent functioning.
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| Scoring and Psychometric Properties |
Scoring: FIM scores for categories of function range from 1 (total or >75% assistance) to 7 (complete independence). Total raw score range = 18-126. Five item Cognitive subscore ranges from 5-35. Scores may be used raw or converted to interval scores. Higher scores suggest 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.
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| 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.
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| 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.
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| Rationale/Justification |
NeuroRehab Specific:
Strengths: Very strong use in both inpatient rehab and longitudinal follow-up research. Strong psychometrics, reliability, sensitive to change, very extensive literature. Observational based on therapists or self-report.
Weaknesses: Training needs to be purchased, no longer required to be measured in inpatient rehab. Scoring accuracy is limited by inter-rated reliability.
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| 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 Mar;79(3):235-240.
Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6-18.
Document last updated January 2022
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