| |
What is the FIM™ instrument*?
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.
Developing a Measure of Function
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.
The FIM™ instrument 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.
* FIM and WeeFIM are trademarks of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.
|
| |
