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FUNCTIONAL INDEPENDENCE MEASURE
The FIM instrument refers to a scale that is used to measure one's ability to function with independence. The initials originally were used to stand for "Functional Independence Measure" but the company that created it no longer refers to it as such.
WHERE IS THE FIM INSTRUMENT USED?
The FIM is used worldwide in medical rehabilitation units.
WHEN ARE FIM SCORES COLLECTED?
A FIM score is collected within 72 hours after admission to the rehabilitation unit, within 72 hours before discharge, and between 80 to 180 days after discharge.
Functional Independence Measure
WHAT ARE THE RANGE OF SCORES ON THE FIM INSTRUMENT?
The FIM score ranges from 1 to 7, with 1 (Total Assistance) being the lowest possible score and 7 (Complete Independence) being the best possible score.
WHAT DOES EACH FIM SCORE MEAN?
The specific FIM scores are as follows, from lowest to highest. A score of "1" means "Total Assistance," in which the person puts forth less than 25% of the effort necessary to do a task. A score of "2" means "Maximal Assistance," in which the person puts forth less than 50% of the effort necessary to do a task, but at least 25%. If someone gets a score of "1" or "2" on the FIM scale, he/she is classified as having "Complete Dependence," because the person puts forth less than half the energy, requires maximal or total assistance, or the activity is not performed at all.
A score of "3" on the FIM scale means "Moderate Assistance," in which the person puts forth between 50% and 74% of the effort necessary to do a task, and requires no more than helping or touching. A score of "4" means "Minimal Contact Assistance," in which the person puts forth 75% or more of the effort necessary to do a task, and requires no more help than touching.
A score of "5" means "Supervision or Setup," in which the person only needs someone to standby and cue or coax him/her (without physical contact) so that he/she can do a task. A score of "5" can also be obtained if a helper is needed to set up items or assistive devices for the person. If someone gets a score of "3," "4," or "5," on the FIM scale, he/she is classified as having "Modified Dependence," because the person can at least put forth half or more of the energy to complete the task.
A score of "6" on the FIM scale means "Modified Independence," in which no helper is needed and the person needs an assistive device. A score of "6" can also be obtained when no help is needed but the person takes more than a reasonable amount of time to do a task or may complete the task in an unsafe manner. A score of "7" means "Total Independence," in which no helper is needed and the person performs the task safely, within a reasonable amount of time, and without assistive devices or aids. If someone gets a score of "6" or "7" on the FIM scale, he/she is classified as being "Independent," because another person is not needed to complete the activity.
WHAT AREAS OF FUNCTIONING ARE FIM SCORES APPLIED TO?
The FIM score is applied to the following areas: eating, grooming, bathing, dressing (upper body), dressing (lower body), toileting, bladder management, bowel management, transferring (to go from one place to another) in a bed, chair, and/or wheelchair, transferring on and off a toilet, transferring into and out of a shower, locomotion (moving) for walking or in a wheelchair, and locomotion going up and down stairs. The FIM score is also used for cognitive areas such as comprehension, expression, social interaction, problem solving, and memory. Many FIM areas are considered activities of daily living (ADLS) which are activities one performs in the course of daily life.
CAN ANYONE GIVE A PATIENT A FIM SCORE?
No. One needs to be a licensed clinician trained in the FIM SystemŽ before assigning scores to people. This involves watching training videos, observing others in practice, and taking a credentialing exam.
WHO TYPICALLY ASSIGNS FIM SCORES?
The typical people in a medical setting who assign FIM scores are physical therapists, occupational therapists, nurses, psychologists, and social workers.
DO HEALTH CARE WORKERS NEED TO BE CERTIFIED IN FIM ASSESSMENT?
Clinicians need to pass a test on how to administer and interpret the FIM instrument measures if their hospital/rehabilitation facility wants to be part of the national FIM database. This database is maintained by Uniform Data System for Medical Rehabilitation (UDSMR), which is a division of the University of Buffalo Foundation Activities, Inc (UBFA), the not-for-profit corporation that developed and owns the FIM instrument. The actual certification, however, does not go to the individual, but goes to the hospital/facility where the FIM instrument is used. 80% of the staff who perform assessments must have passed this credentialing test in order for it to be certified by UDSMR with a passing score of at least 80%.
There are some hospital/facilities that do not wish to pay the fee to be part of the national FIM database. Such places do not need to be certified. The consequence of not being part of the national FIM database is that they cannot obtain national comparison ranking scores for their institution versus others.
IF I PASSED THE TEST TO DO FIM ASSESSMENT AT ONE INSTITUTION DOES THAT TRANSFER TO OTHER INSTITUTIONS?
No. If an employee passed the test at hospital A and move to hospital B, the passing score will not be transferred. Thus, the employee would have to take the test again at the new institution. The test and training however are relatively brief. The reason the passing score does not transfer with the individual is because it is not the individual, but the institution that is certified in FIM assessment.
IS THE FIM SCALE COPYRIGHTED?
Yes, the FIM instrument is copyrighted by UBFA. Feel free to contact UDSMR directly for any information you may need.