The Functional Independence Measure: A Measurement of Disability and Medical Rehabilitation

Abstract

Measuring outcomes in medical rehabilitation must begin with an understanding of what is to be measured, and this understanding must be grounded in theory and connected to a comprehensive model for meeting the needs of the patient. Measurement tools for outcomes must then be designed and tested with respect to their purpose, practicality, construction, standardization, reliability, and validity. This chapter proposes a conceptual model called Challenges to the Quality of Daily Living that is based on the work of Abraham Maslow. The model describes the goal of fulfillment as achieving a balance between one’s choices, options, and expectations on the one hand (functional opportunities), with one’s physical, cognitive, and emotional constraints (functional demands/barriers) on the other. While these opportunities and demands are not directly measurable in qualitative or quantitative terms, the underlying factors supporting or forming barriers to health and function are measurable. The Functional Independence Measure (FIM) and the Uniform Data System for Medical Rehabilitation (UDSmr) are examined from the perspectives described above, and are found to provide practical measurement for patients undergoing medical rehabilitation for conditions that render them dependent on others for assistance in activities of daily living. The FIM has been shown to be reliable, valid, feasible, practical, and sensitive to clinical change in functional independence at admission, discharge, and follow-up. Use of the FIM and the UDSmr characterizes disability and change in severity through the use of a uniform language, and has important implications for national and international exchange of comparable information concerning outcomes.