An inter-rater reliability study of the Functional Assessment Measure (FIM+FAM)

There is an increasing demand for measures of outcome to evaluate the effects of rehabilitation interventions for brain injury from clinicians, research workers and healthcare providers and purchasers. The Functional Assessment Measure (FIM+FAM), an expanded derivative of the Functional Independence Measure (FIM), is designed specifically for this purpose for this patient group. This study examined the interrater reliability of the FIM+FAM between two independent raters, a physician and a nurse, the subjects being 30 in-patients in a neurological rehabilitation unit. The results show that the inter-rater reliability was good (kappa values 0.50 to 0.95) for all but one of the 30 items rated on the FIM+FAM. The exception (with a kappa value of 0.35) was "adjustment to limits'. Higher agreement was found for rating of physical activities than for cognitive, communication and behavioural items.