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The structure and stability of the Functional Independence Measure
J M Linacre1, A W Heinemann, B D Wright
1MESA Psychometric Laboratory, Department of Education, University of Chicago.
Archives of Physical Medicine and Rehabilitation
|February 1, 1994
Summary
Rasch analysis of the Functional Independence Measure (FIM) reveals distinct motor and cognitive disability indicators in rehabilitation patients. These validated measures allow for reliable assessment of patient status changes over time.
Area of Science:
- Rehabilitation Medicine
- Psychometrics
- Disability Assessment
Background:
- The Functional Independence Measure (FIM) is widely used to quantify disability in rehabilitation.
- A challenge exists in relating FIM's finite raw scores to the continuous nature of disability.
- Rasch analysis offers a method to address this psychometric challenge.
Purpose of the Study:
- To apply Rasch analysis to FIM data to resolve score limitations.
- To identify distinct dimensions of disability measured by the FIM.
- To validate measures for assessing patient change in rehabilitation.
Main Methods:
- Rasch analysis was performed on admission and discharge FIM ratings.
- A large dataset of 14,799 rehabilitation patients was analyzed.
- The 18 FIM items were evaluated for their psychometric properties.
Main Results:
- The 18 FIM items were found to define two distinct indicators: motor and cognitive functions.
- Thirteen items related to motor function disability.
- Five items related to cognitive function disability.
Conclusions:
- The FIM effectively measures both motor and cognitive disability.
- Additive measures derived from these indicators demonstrate consistent properties at admission and discharge.
- These Rasch-derived measures are suitable for tracking patient progress in rehabilitation.