Interrater reliability of the functional assessment measure in a brain injury rehabilitation program

doi:10.1016/S0003-9993(98)90267-2

Archives of Physical Medicine and Rehabilitation

Volume 79, Issue 10, October 1998, Pages 1231-1236

https://doi.org/10.1016/S0003-9993(98)90267-2 Get rights and content

Abstract

Objective: To examine the interrater reliability and completion time of the Functional Assessment Measure, which is the Functional Independence Measure (FIM™) plus additional items (FIM+FAM).

Design: Interrater reliability study.

Setting: Inpatient rehabilitation units of a postacute care brain injury rehabilitation program.

Patients: A convenience sample of 53 extremely severely impaired adult survivors of traumatic brain injuries (40 men, 13 women, mean age 38yrs).

Main Outcome Measures: Treatment team members' ratings of the 30 FIM+FAM items, and time taken to complete the FIM+FAM.

Results: Intraclass Correlation Coefficients (ICCs) were within the good to excellent range (ICC > .60) for 29 of 30 items and for all subscales except psychosocial adjustment. Higher mean ICC values were obtained for motor domain items than for cognitive/psychosocial domain items. Treatment teams became progressively faster over a 12-week period in completing the FIM+FAM.

Conclusions: The generally good to excellent range interrater reliability found in this study helps support the use of the FIM+FAM in rehabilitation settings. Further support was obtained for the finding that motor items are more reliable than cognitive and psychosocial items. Administration of the FIM+FAM can be done in a timely manner in a rehabilitation setting.

References (13)

KJ Ottenbacher et al.
The reliability of the Functional Independence Measure: a quantitative review
Arch Phys Med Rehabil
(1996)
NM Crewe et al.
Functional assessment
KM Hall et al.
Characteristics and comparisons of functional assessment indices: Disability Rating Scale, Functional Independence Measure, and Functional Assessment Measure
J Head Trauma Rehabil
(1993)
KM Hall et al.
Outcomes evaluation in TBI rehabilitation, part II: measurement tools for a nationwide data system
Arch Phys Med Rehabil
(1994)
KM Hall et al.
Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS, and CIQ
J Head Trauma Rehabil
(1996)
KM McPherson et al.
An interrater reliability study of the Functional Assessment Measure (FIM+FAM)
Disabil Rehabil
(1996)

There are more references available in the full text version of this article.

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Citation Excerpt :
As this technology becomes increasingly common and more hospitals develop LVAD programs, awareness of the role of acute inpatient rehabilitation units (IRUs) as part of the multidisciplinary LVAD team is crucial and may improve patient functional outcomes, quality of life, and length of stay (LOS). Previous studies have demonstrated the utility of the Functional Independence Measure (FIM) as a method for quantifying patient disability and level of assistance needed to carry out activities of daily living (ADLs) in numerous patient populations, including those with brain injury, Parkinson disease, spinal cord injury, and stroke [6-10]. The FIM permits quantification of the assessment of patient independence in key motor and cognitive ADLs, including eating, grooming, mobility, cognition, and bladder and bowel management [11].
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IV
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ArticleInterrater reliability of the functional assessment measure in a brain injury rehabilitation program☆

Abstract

Arch Phys Med Rehabil

Functional assessment

Characteristics and comparisons of functional assessment indices: Disability Rating Scale, Functional Independence Measure, and Functional Assessment Measure

J Head Trauma Rehabil

Outcomes evaluation in TBI rehabilitation, part II: measurement tools for a nationwide data system

Arch Phys Med Rehabil

Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS, and CIQ

J Head Trauma Rehabil

An interrater reliability study of the Functional Assessment Measure (FIM+FAM)

Disabil Rehabil

Article
Interrater reliability of the functional assessment measure in a brain injury rehabilitation program☆