What is FIM?

FIM stands for Functional Independence Measure, an assessment tool doctors, therapists, and nurses use during rehabilitation and physical therapy.

FIM gauges and track the amount of assistance that a person may require to carry out everyday activities.

What parameters does FIM measure and how is an FIM score calculated? How can FIM be a useful tool for both you and your care team? Continue reading to find out.

FIM consists of 18 different items to evaluate functions like self-care, mobility, and communication. The ability to perform each of the 18 FIM items independently is carefully assessed and scored on a numerical scale.

Because each item corresponds to activities that are involved in day-to-day functions, your FIM score can give you a good idea about the level of care or assistance you may need in performing specific actions.

FIM can be used for a variety of conditions and rehabilitation scenarios, such as:

The 18 items of the FIM assessment tool are divided into motor and cognitive categories. Each item is also classified based on the type of task it involves.

The clinician performing the assessment scores each item on a scale of 1 to 7. The higher the score is for a task, the more independent a person is at performing the task.

For example, a score of 1 indicates that a person needs total assistance with a task, while a score of 7 means a person can perform a task with complete independence.

After all items have been assessed, a total FIM score is calculated. This score is a value that ranges between 18 and 126.

The FIM score can also be further broken down based on its motor and cognitive components. The motor component of the FIM score can range between 13 and 91, while the cognitive component can range between 5 and 35.

Following are the items evaluated by the FIM assessment.

Motor category

Self-care tasks

item 1eatingusing proper utensils to bring food to the mouth as well as chewing and swallowing
item 2groomingaspects of personal grooming, including hair brushing, teeth cleaning, washing the face, and shaving
item 3bathingwashing, rinsing, and drying oneself in a tub or shower
item 4upper body dressingdressing oneself above the waist, and can also include putting on or removing a prosthesis
item 5lower body dressingdressing oneself from the waist down, and like category 4, can also include putting on or removing a prosthesis
item 6toiletingproperly cleaning up and adjusting clothing after using the toilet

Sphincter control tasks

item 7bladder managementcontrolling the bladder
item 8bowel managementcontrolling bowel movements

Transfer tasks

item 9bed-to-chair transfertransferring from lying down in a bed to a chair, wheelchair, or a standing position
item 10toilet transfergetting on and off of a toilet
item 11tub or shower transfergetting into and out of a tub or shower

Locomotion tasks

item 12walk or wheelchairwalking or using a wheelchair
item 13stairsgoing up and down one flight of stairs indoors

Cognitive category

Communication tasks

item 14comprehensionunderstanding of language as well as written and verbal communication
item 15expressionability to express oneself clearly both verbally and nonverbally

Social cognition tasks

item 16social interactiongetting along and interacting with others in social or therapeutic situations
item 17problem-solvingsolving problems and making responsible decisions associated with day-to-day activities
item 18memoryremembering information associated with performing daily activities

The FIM assessment tool is administered by clinicians who are trained in using it. These clinicians must complete training and pass an exam in order to assign FIM scores.

An initial FIM score is typically determined within 72 hours of admission to a rehabilitation facility. This gives your care team a good baseline to work with as you begin your rehabilitation program.

Additionally, the breakdown of your FIM score can also help set specific goals for you prior to your discharge from the facility.

For example, if you enter a rehabilitation facility with a mobility (item 12) rating of 3 (moderate assistance required), the care and physical therapy team may target a rating of 5 (supervision required) as a goal prior to discharge.

Since the total FIM score can also be broken down into separate motor and cognitive categories, your care team may target specific values in one or both of those categories as well.

For example, one study of people who had received rehabilitative care for a hip fracture found that a motor FIM score of 58 was associated with an increased likelihood of discharge back into the community (as opposed to being discharged to another care facility or program).

The FIM assessment is performed again within 72 hours of discharge from a rehabilitation facility. This can provide both you and your care team with an indicator of the amount of assistance you’ll need in your specific day-to-day activities.

For example, according to the Uniform Data System for Medical Rehabilitation organization, a total FIM score of 60 can equate to approximately four hours daily of assistance needed while a score of 80 equates to about two hours daily. People with a total FIM score between 100 and 110 require minimal assistance with their day-to-day activities.

Additionally, the difference between your initial FIM score and your score at discharge is also a good indicator of progress you’ve made during your rehabilitation period.

The FIM score is just one of many tools that clinicians can use to determine independence or amount of assistance needed in a rehabilitation setting as well as after discharge.

The types of tools used for evaluation may vary depending on your condition or specific scenario.

Nevertheless, the FIM score can be useful to both you and your care team for a variety of reasons, including:

  • setting improvement goals for your rehabilitation program
  • evaluating the amount of assistance you may need in your daily activities
  • tracking your progress as you complete your rehabilitation program

Physical therapy and rehabilitation is a long process that requires consistent attempts and persistence.

Determining a physical therapy treatment plan can be a complex process involving obtaining a thorough medical history as well as reviewing the results of various exams or assessments.

Clinicians can synthesize the information they’ve obtained from these things to determine your outlook and a care plan.