Rasch analysis of the functional independence measure (FIM™) mastery test

doi:10.1016/S0003-9993(98)90208-8

Archives of Physical Medicine and Rehabilitation

Volume 79, Issue 1, January 1998, Pages 52-57

https://doi.org/10.1016/S0003-9993(98)90208-8 Get rights and content

Abstract

Objective: To evaluate the range, distribution, and unidimensionality of the items included in Version Five of the Functional Independence Measure (FIM^TM) Mastery Test, a 54-item written examination used to determine FIM rating proficiency by professionals who administer the instrument.

Study Design: Rasch analysis of the test results of 6,645 clinicians who took the FIM Mastery Test in 1996.

Results: Overall, clinicians performed well on the test. When the mean item difficulty was centered at 50, and the test scores were calibrated to range from 0 to 100 logits, the mean person ability level was 77 logits. Fit statistics indicated that the test was unidimensional, measuring a common theme. While the item separation index value was 17, 22 items were not efficient in determining the clinicians' ability levels. Analysis of the logit values by the correct response showed that descriptions of Total Assistance (Level 1) and Complete Independence (Level 7) were easiest for clinicians to score correctly.

Conclusion: The examination measures the common theme of FIM knowledge in a consistent manner. Further, the results suggest that the FIM Mastery Test may be shortened, perhaps by eliminating one of the three case studies, and improved by adding more challenging questions. In addition, FIM training should focus on distinguishing among levels 2 through 6, since clinicians had more difficulty identifying these levels.

References (24)

KJ Ottenbacher et al.
Inter-rater agreement and stability of functional assessment in the community-based elderly
Arch Phys Med Rehabil
(1994)
PM Smith et al.
Intermodal agreement of follow-up telephone functional assessment using the Functional Independence Measure in patients with stroke
Arch Phys Med Rehabil
(1996)
KJ Ottenbacher et al.
The reliability of the Functional Independence Measure: a quantitative review
Arch Phys Med Rehabil
(1996)
CV Granger et al.
Functional assessment scales: a study of persons with multiple sclerosis
Arch Phys Med Rehabil
(1990)
CV Granger et al.
Functional assessment scales: a study of persons after stroke
Arch Phys Med Rehabil
(1993)
CV Granger et al.
Functional assessment scales: a study of persons after traumatic brain injury
Am J Phys Med Rehabil
(1995)
PB Disler et al.
Predicting hours of care needed
Arch Phys Med Rehabil
(1993)
AW Heinemann et al.
Relationship between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury
Arch Phys Med Rehabil
(1997)
MG Stineman et al.
The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories
Arch Phys Med Rehabil
(1996)

BB Hamilton et al.

Interrater reliability of the 7-level Functional Independence Measure

Scand J Rehabil Med

(1994)

N Chau et al.

Inter-rater agreement of two functional independence scales: the Functional Independence Measure (FIM) and a subjective uniform continuous scale

Disabil Rehabil

(1994)

Cited by (48)

Effect of Care Capacity on Stroke Patients’ Recovery in Activities of Daily Living: A Multi-Hospital Study
2020, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
The FIM is an 18-item, seven level, ordinal scale. The FIM is the product of an effort to resolve the long-term problem of a lack of uniform measurement and data on disability and rehabilitation outcomes.25 This 18-item ordinal scale can be calculated as a summary score and two subscale scores of motor and cognitive function; the higher the score is, the more independent a patient's function is.26
This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity.
Retrospective, observational, longitudinal study.
Acute phase hospitals.
From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0–3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8–60 days.
The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation.
Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke.
These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.
Construct validity of the Trunk Aesthetic Clinical Evaluation (TRACE) in young people with idiopathic scoliosis
2020, Annals of Physical and Rehabilitation Medicine
Citation Excerpt :
In the Rasch analysis framework, a sample size of 300 participants estimates both items and persons accurately [26]. However, larger sample sizes obviously increase the precision of the estimates and are common in Rasch studies [27]. To evaluate the TRACE with better accuracy, we chose to recruit about 1500 participants that is, 5 times more the 300 threshold.
Aesthetics is recognized as a main outcome in idiopathic scoliosis (IS) treatment, but to date, there is no criterion standard for physicians’ evaluation. Trunk Aesthetic Clinical Evaluation (TRACE) is a simple 12-point ordinal scale to quantify symmetry as a proxy of aesthetics. TRACE is already diffused worldwide and has been used in clinical research.
We aimed to validate TRACE and improve it with Rasch analysis.
This study involved an observational Rasch analysis validation of an evaluation tool in outpatient rehabilitation centres. From a clinical database, we randomly selected patients who had IS, were age 10 to 18, had brace prescription at first evaluation, and had at least 2 consultations. Rasch analysis (partial credit model) was used. Differential item functioning (DIF) was assessed for age, sex, disease severity, bracing and treatment. The median was chosen to dichotomize disease severity and bracing. We removed 64 outlier participants (4%).
We included 1553 participants (1334 females; mean [SD] age 13 [1.7] years old). TRACE items showed ordered thresholds and proper fit to the Rasch model. The score-to-measure conversion table showed proper length (range −4.55 to 4.79 logit) with a mean (SE) measure of −0.52 (0.04) logit. The principal component analysis supported the TRACE unidimensionality. The TRACE was free from DIF for age, sex and bracing.
The TRACE ordinal scale has been converted into a Rasch-consistent, interval-level measure of trunk aesthetics in IS patients and can be used to compare different populations. Its main flaw is low reliability, likely because of the small number of items. TRACE can be used as an outcome measure and in everyday clinical evaluation of IS, even if new developments of the scale are advised.
Influence of Relative Strength on Functional Independence of Patients With Spinal Cord Injury
2017, Archives of Physical Medicine and Rehabilitation
To investigate the influence of strength values and fat mass on functional independence of men with different spinal cord injury (SCI) levels.
Cross-sectional study.
Hospital network.
Men with SCI (N=45).
Subjects were assessed in functional independence scales, a 1 repetition maximum (1RM) test, and body composition to detect absolute and relative strength: 1RM divided by body mass (BM) and lean body mass (LBM), respectively.
Stepwise multiple regression analysis was used to verify the influence of predictors on functional independence (FIM and Spinal Cord Independence Measure [SCIM] scale and subscales). Receiver operating characteristic curves were created to identify cutoff points of strength for functional independence.
The best models for FIM total, FIM mobility, and SCIM total used 1RM as the best predictor (adjusted R²=.75, .67, and .65, respectively; P<.05). Relative strength (1RM/LBM) was the best predictor for SCIM mobility (adjusted R²=.62, P<.05). A FIM score of 69 has a 1RM cutoff point of 50.1kg, and a FIM score of 76 has cutoff points of .73 for 1RM/BM and .91 for 1RM/LBM. A SCIM score of 68 has cutoff points for 1RM, 1RM/BM, and 1RM/LBM of 50.1kg, .77, and .92, respectively.
Cutoff points of relative strength should be used as determinant variables for independence, health, or sports performance. This study may contribute to more adequate guidance of physical activity during a rehabilitation program and after discharge.
Functional Independence: A Comparison of the Changes During Neurorehabilitation Between Patients With Nontraumatic Subarachnoid Hemorrhage and Patients With Intracerebral Hemorrhage or Acute Ischemic Stroke
2017, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Each item is scored on an ordinal 7-point scale, where a score of 1 indicates total dependency and 7 indicates complete independence. The FIM total sum score ranges from 18 to 126 and can be divided into a motor (13 items) and a cognitive (5 items) subscore.27 Furthermore, since rehabilitation outcome has mostly been reported as a sum score,5-7,16,28 or dichotomized as a “good” or “bad” outcome,1,29 we compared functional independence by item-by-item FIM; these measurements would provide health care professionals with the information needed to tailor interventions or compare specific neurorehabilitation outcomes.15,30
To compare the changes in functional independence measured by the FIM after specialized neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage (SAH) and patients with intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS).
Historical cohort study comparing changes in functional independence between patients with nontraumatic SAH and those with ICH/AIS, using FIM scores from a local database and clinical information from the Danish National Patient Registry.
Postacute specialized inpatient neurorehabilitation.
Participants (N=660) comprised patients with a first-time nontraumatic SAH (n=212) and age-matched patients with a first-time ICH/AIS (n=448).
Not applicable.
Crude and adjusted comparisons of FIM (total and item by item) measured at baseline and at discharge.
Patients with nontraumatic SAH were admitted with a lower functional level compared with patients with ICH/AIS (median total FIM score, 25 [interquartile range (IQR), 18–81] vs 78.5 [IQR, 47–107]), and discharged with a lower functional level (median total FIM score, 98 [IQR, 40–116] vs 110 [IQR, 82.5–119]), although they made more progress during neurorehabilitation (median change in total FIM score, 27 [IQR, 4–60] vs 17 [IQR, 7–35]). Statistically, patients with nontraumatic SAH had significantly better odds for obtaining functional independence than did patients with ICH/AIS in 6 of the 18 FIM items: eating (odds ratio [OR]=3.2; 95% confidence interval [CI], 1.7–5.8); dressing–upper body (OR=2.0; 95% CI, 1.1–3.5); transfer tub/shower (OR=2.0; 95% CI, 1.1–3.6); stair walking (OR=2.2; 95% CI, 1.3–3.7); comprehension (OR=2.3; 95% CI, 1.3–3.9); and expression (OR=3.6; 95% CI, 2.0–6.5).
Patients with nontraumatic SAH made significantly more progress during neurorehabilitation, although they were discharged with a lower level of functional independence compared with patients with ICH/AIS. However, both patients with nontraumatic SAH and those with ICH/AIS improved their functional outcome significantly. Also, patients with nontraumatic SAH admitted with severe functional outcome were shown to be capable of recovering to a moderate level of functional independence.
Measurement instruments most frequently used in the evaluation of traumatic brain injury
2014, Rehabilitacion
La heterogeneidad de secuelas tras un traumatismo craneoencefálico (TCE) hace que la descripción del espectro funcional sea compleja. Por ello es esencial el uso de instrumentos de medida para evaluar su estado funcional, así como su evolución a lo largo del tiempo.
Identificar qué escalas son las más frecuentemente empleadas en esta población. Estrategia de búsqueda: se realizó una búsqueda sistemática de escalas a través de Pubmed, Embase y psycINFO.
La Functional Independence Measure (FIM), la Glasgow Outcome Scale (GOS), la Disability Rating Scale (DRS), el Barthel Index (BI), el Community Integration Questionnaire (CIQ), el Rancho Los Amigos Level of Cognitive Functional Scale (RLS LCFS) y varios test cognitivos Wechsler Adult Intelligence Scale (WAIS), el Wisconsin Card Sorting Test (WCST), el Galveston Orientation Amnesia Test (GOAT), el California Verbal Learning Test (CVLT) y el Mini-mental State Examination (MMSE) aparecieron nombrados en más del 10% de los artículos.
La complejidad de secuelas tras un TCE explica la gran cantidad de escalas halladas. El presente artículo proporciona información sobre las más frecuentemente empleadas, así como sus características, permitiendo a los clínicos e investigadores seleccionar el instrumento de medida que más favorezca su área de interés.
The description of the functional spectrum after Traumatic Brain Injury (TBI) is complex due to the heterogeneity of its sequels. Thus, use of measurement instruments is of utmost importance to evaluate its functional status and evolution throughout time.
To identify the scales used most frequently in this population. Search strategy: A systematic search was done for scales using Pubmed, Embase and psycINFO.
The Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), Barthel Index (BI), Community Integration Questionnaire (CIQ), Rancho Los Amigos Level of Cognitive Functional Scale (RLS LCFS) and several cognitive tests - Wechsler Adult Intelligence Scale (WAIS), Wisconsin Card Sorting Test (WCST), Galveston Orientation Amnesia Test (GOAT), California Verbal Learning Test (CVLT) and Mini-mental State Examination (MMSE) were used in more than 10% of the articles.
The complexity of sequels after TBI explains the large amount of scales found. This article provides information on the most frequently used scales as well as their characteristics, allowing the clinicians and researchers to choose the best measurement instrument for their area of interest.
Assessment of value change in adults with acquired disabilities
2006, Clinician's Handbook of Adult Behavioral Assessment
This chapter discusses self-report measures of values for use with the individuals who have acquired disabilities, and suggests methods that could contribute to a new generation of such measures. In addition, it discusses research on measures of values with this population, and the methods to improve the measurement of values for use in medical and psychosocial rehabilitation. The chapter focuses on measures of values that are completed by the rehabilitation customers or that are completed with the assistance of their significant others, or rehabilitation professionals. A review of the importance of values to rehabilitation interventions indicates that values influence the ways people interpret the impact and meaning of their disabilities. Moreover, values influence rehabilitation success. Therapeutic benefits are thought to increase when persons with acquired disabilities examine their values and, if needed, modify them in an effort to reflect current and future abilities and limitations, and through this process, redefine the important life goals in realistic and positive ways.

View all citing articles on Scopus

^☆: FIM is a trademark and UDSMR is a service mark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities Inc.

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

View full text

ArticleRasch analysis of the functional independence measure (FIM™) mastery test☆,☆☆

Abstract

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Functional assessment scales: a study of persons with multiple sclerosis

Arch Phys Med Rehabil

Functional assessment scales: a study of persons after stroke

Arch Phys Med Rehabil

Functional assessment scales: a study of persons after traumatic brain injury

Am J Phys Med Rehabil

Predicting hours of care needed

Arch Phys Med Rehabil

Relationship between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury

Arch Phys Med Rehabil

The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories

Arch Phys Med Rehabil

Interrater reliability of the 7-level Functional Independence Measure

Scand J Rehabil Med

Inter-rater agreement of two functional independence scales: the Functional Independence Measure (FIM) and a subjective uniform continuous scale

Disabil Rehabil

Article
Rasch analysis of the functional independence measure (FIM™) mastery test☆,☆☆