What is the FIM™ instrument*?
The FIM™ instrument is a basic indicator of severity of disability. The functional ability of a patient changes during rehabilitation and the FIM™ instrument is used to track those changes which are a key outcome measure of rehabilitation episodes.
The FIM™ instrument comprises 18 items, each of which is assessed against a seven point ordinal scale, where the higher the score for an item, the more independently the patient is able to perform the tasks assessed by that item. Total scores range from 18 to 126. The items are divided into two major groups, the Motor items, of which there are 13, and the Cognitive Items, of which there are 5. The rating scale designates major graduations in behaviour from dependence to independence. The scale provides for the classification of individuals by their ability to carry out an activity independently, versus their need for assistance from another person or a device. If help is needed the scale assesses the degree of that need.
Prior to 1984 clinicians had no universally accepted terminology to communicate about disability. To address this issue, the National Institute on Disability and Rehabilitation Research of the US Dept Education awarded a grant to the Dept of Rehabilitation Medicine, School of Medicine and Biomedical Sciences at the State University of New York at Buffalo to develop a system to document severity of patient disability and the outcomes of medical rehabilitation.
A task force representing the US rehabilitation community set about developing the Uniform Data System for Medical Rehabilitation (UDSMR) a minimum data set that includes a rating scale to measure function, the Functional Independence Measure (FIM™ instrument ). It is now widely used around the world, including in Australia.
AROC holds the territory license for the use of the FIM™ (and WeeFIM®) instruments in Australia, and is the national certification and training centre for these tools. All clinicians undertaking assessments are trained in the use of the tools, and must sit a credentialing exam every two years. In Australia there are three levels of credentialing: clinician, facility trainer and master trainer.
Function is assessed using the FIM™ instrument at admission and discharge. Admission data is collected within 72 hours of admission, and discharge data is collected within the 72 hours prior to discharge. Assessment is undertaken by direct observation by clinicians familiar with the patient’s daily activities, and is often a multidisciplinary process. The score should reflect the actual performance observed.
The timing of the admission scoring is important because clinically, a person’s functional capacity changes upon commencement of a program of rehabilitation. To achieve an accurate base measure it is important that the initial measurement is done in a timely manner. Similarly, it is important that the discharge assessment is done within a time frame that allows the total functional improvement of the patient to be measured. To measure the timeliness of scoring on admission and discharge the AROC data set requires the collection of the date on which each of these scores was achieved. It should also be noted that timeliness of functional assessment on admission and discharge is an ACHS Rehabilitation Medicine clinical indicator.