FIM+FAM – OUTCOME MEASURES
Presented by Caroline Ray
On behalf of Queen Elizabeth’s Foundation Brain
Injury Centre, Banstead, Surrey.
FIM+FAM: A BACKGROUND

Functional assessment measures have been
in use for half a century in rehabilitation to
plan and evaluate care, determine
compensation and predict prognosis.

The Barthel Scale (1965), commonly used by
nursing staff measures activities such as:
feeding, grooming, bathing, dressing,
transfers and mobility but it does not address
cognitive/social issues.
FIM+FAM: A BACKGROUND

In the early 1980s an American task force took
items from existing ‘physical’ scales and
developed the Functional Independence
Measure (FIM).

This was intended to create a global measure
of disability but one which additionally
addressed cognitive/psycho-social issues and
which could be considered to be reliable
regardless of clinical background of user.
FIM+FAM: A BACKGROUND

The FIM is an 18 item measurement that
evaluates a person’s functional status and
abilities. Monitoring of scores therefore reflects
progress and the clients discharge destination.

Functional Assessment Measure extends the
coverage of the FIM and this scale was
developed in the USA and adapted for the UK
in 1993 (last modified in 1999).
FIM+FAM UK: OUTCOME MEASURE

It adds an additional 12 items to the FIM which
are around cognition and tests attention levels,
problem solving, comprehension, expression,
memory and social interaction, reading and
writing skills and employability.

Status on admission, according to FIM+FAM
scales, provides the clinical baselines and
focus for treatment. It is recommended that
the FIM+FAM is scored by a multi-disciplinary
team, which improves inter-rated reliability.
FIM+FAM: QEF BIC MODEL

Levels of dependency in activities of daily
living, cognitive and communication, literacy
and emotional adjustment are regularly
assessed during the students rehabilitation
and at discharge.

Assessment Scale runs from 1 - being the
requirement of total assistance (the individual
performs less that 25% of the task) to 7 complete independence (the task is
completed in a timely and safely manner).
A. N. Other Initial and Discharge - August 2009
Safety Awareness
Concentration
Orientation
Memory
Problem solving
Leisure Activities
Feeding
7
6
5
4
Grooming
Bathing
Dressing upper body
Dressing lower body
Toileting
Swallowing
3
2
Adjustment
Bladder management 1
1
Emotional status
0
Social interaction
Speech intelligibility
Bladder management 2
Initial
Bowel management 1
Discharge
Bowel management 2
Writing
Reading
Expression
Comprehension
Community mobility Stairs
Bed, chair, w/chair
Toilet
Bath or shower
Car transfers
Walking
Wheelchair
EXAMPLE DATA
Level of Dependency of Clients Related to Cognitive and
Communication Abilities
on Admission and at Discharge
30
27
25
19
20
High Dependency
Medium Dependency
15
Low Dependency
10
5
6
5
1
0
Admission
2
Discharge
FIM+FAM: QEF BIC MODEL

Data collected clearly shows the progress that
clients make during their rehabilitation from
which valuable evidence can be extrapolated,
for example:

91% of clients have made progress in
completing personal care, 100% have made
progress with physical skills while a further
75% of clients have made progress with
literacy and cognition.
WHY MEASURE OUTCOMES?





To convince purchasers of services and
demonstrate that rehabilitation is effective
To help direct therapies; identify which areas
to work on
Encourage team communication and joint
working
Data can be used to compare different
services and client populations
Clearly demonstrate progress with physical
and cognitive abilities and the subsequent
reduced ‘burden of care’
Further information

QEF, BIC Contact Head of Clinical Services –
lynne.hensor@qef.org.uk

FIM/FAM training at Northwick Park Hospital, Harrow,
Middx. Oct. 2011 cost £100 per person.

FACS (AHSA)
Assessment to measure functional communication of
adults with speech, language and cognitive
communication disorders (including social
communication, communication of daily needs,
reading, writing, number concepts and daily planning.)