Guide for the Uniform Data Set for Medical Rehabilitation

The Uniform Data Set for Medical Rehabilitation (USDMR) Functional Independence Measure (FIM) is a system for measuring a disabled person's degree of physical disability. Used by medical facilities throughout the world, the system enables everyone involved to measure disability in a standard way. Founded in 1987 and operated as a not-for-profit organization on the campus of the University of Buffalo, The State University of New York, UDSMR contains the largest database of medical rehabilitation outcomes in the world.

Background

• FIM was designed to document a range of disability from totally dependent to completely independent functioning. The FIM uses 18 items that measure a patient's degree of disability and the amount of care that will be required. It is able to provide this information because a vast amount of data is available from which conclusions and predictions can be drawn.

  FIM has been the subject of a number of studies, which have found it to be highly valid and reliable. By validity is meant that the data from which it collects what it is intended to measure is reliable and conclusive. Its reliability refers to the fact that its results are consistently dependable.

Measurement Scale

• The items included on the FIM will usually be measured by trained care providers, therapists or physicians at the entry and discharge of patients from a facility. Using a seven-point scale, the scorers grade their observations according to the degree of patient functioning dependency. A patient for whom no help is required is scored as having Complete Independence. A Modified Independence determination indicates there was a small amount of dependence on a helper. The next level is Supervision only. A Minimal Assistance score requires that the care recipient showed at least 75 percent independence, Moderate Assistance indicates 50 percent independence, while Maximal Assistance patients were able to demonstrate at least 25 percent independence. Total Assistance, the most disabled category, ranges from less than 25 percent independence to total dependence.

User Facilities

• A stroke sufferer or a person who has fallen off a moving motorcycle and sustained a head injury, for instance, will most likely suffer damage that will eventually require rehabilitation treatment. Hospitals, skilled nursing facilities, rehabilitation centers and inpatient and outpatient rehabilitation clinics will measure patient abilities with the FIM to determine the extent of the care that will be required.

  Rehabilitation facilities use the FIM for planning personnel requirements, measuring progress of patients, planning potential discharges or transfers of patients and advertising the success of their programs.

Physical Components

• The physical components measured, using the seven-point scale described above, are: 1, eating; 2, grooming; 3, bathing; 4, dressing the upper body; 5, dressing the lower body; 6, toileting; 7, bladder management; 8, bowel management; 9, bed, chair and wheelchair use; 10, toilet use; 11, tub and shower use; 12, walking and 13, stair climbing.

  Components 1 to 6 are identified as self-care, 7 and 8 as sphincter control and the remainder as mobility.

Cognitive Components

• The cognitive components are divided into communication and social cognition. These components are: 14, comprehension from speech; 15, expression by speech; 16, social interaction; 17, problem solving and 18, memory.