TY - JOUR
T1 - The functional independence measure
T2 - Tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories
AU - Stineman, Margaret G.
AU - Shea, Judy A.
AU - Jette, Alan
AU - Tassoni, Charles J.
AU - Ottenbacher, Kenneth J.
AU - Fiedler, Roger
AU - Granger, Carl V.
N1 - Funding Information:
Prom the Department of Rehabilitation Medicine, the Leonard Davis Institute of Ilealth Economics. and the Center for Clinical Fqidemiology and Riostatistics (Dr. Stineman), the Department of Medicine, Section of General Intcmal Medicine (fir. Shea. Dr. Tassoni), University of Pennsylvania. Philadelphia; the New England Research Institute (Dr. Jette); and the School Health Related Professions (Dr. Ottenbacber) and Depanmenr of Rehabilitation Medicine (Dr. Fiddler. Dr. Granger). State University of New York at Buffalo. Submitted for publication September 20, 1995. Accepted in revised form April 8.1996. Supported in part by National Institutes of Health gram KOg-AG004R7 from tbe National Institute on Aging and Agency for Heallh Care Policy and Research gram ROI-HS07595. The opinions and conclusions of the authors are nor necessarily those of the sponsoring agencies. UDSW?‘” is a service mark of the Uniform Data System for Medical Rehabilitation. a division of UB; Foundation Activities, Inc. No commercial pw having a direcf 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. Dr. Ottenbacher is ROW associated with the University of Texas School of Allied Ilealth Science. Galveston. Dr. Tassoni is now associated with the Drpartmenl of Statisti~l EpidemiolT. Johns .l,l opkins Univenity. Baltimow, MD. Reprint rquesa to argaret G Stmeman, MD. 101 Ralston-Penn Center. 3615 Chestnut Street. Philadelphia, PA 191042676 8 1996 by lhe Ameiican Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehahilitalion 0003-9993~71 I-3697$3.00/O
PY - 1996/11
Y1 - 1996/11
N2 - Objective: The analysis presented here evaluated the psychometric properties of the Functional Independence Measure (FIM) as a summated rating scale within context of the 20 impairment categories of the FIM-Function Related Group (FIM-FRG) system. Design: This study involved a cross-sectional analysis of patient records, utilizing factor analysis and techniques of multitrait scaling to verify the summative properties of the motor and cognitive dimensions of the FIM and to study the statistical properties of admission FIM scores. Patients: Included were a total of 93,829 patients discharged from 252 freestanding rehabilitation hospitals and units during calendar year 1992. Cases were excluded that had missing or out-of-range values or atypical lengths of stay. These criteria were developed previously in conjunction with an expert clinical panel and confirmed through statistical analyses. Results: Factor analyses supported the motor and cognitive dimensions across all 20 impairment categories. The resulting subscales exceeded minimum criteria for item internal consistency in 96.9% of tests and item discriminant validity in 100% of tests. Reliability coefficients for each impairment category for both subscales ranged from .86 to .97. There were no major ceiling effects, but patients in certain impairment categories were unable to climb stairs at admission. Conclusion: The psychometric properties of the summated FIM compare favorably to most standardized health measures used in medical practice. Findings provide support for the motor and cognitive subscales as used in the FIM-FRGs. As a unidimensional scale, the FIM quantifies care burden. Split into the motor and cognitive (as used in the FIM-FRGs) it distinguishes physical disabilities from those arising from communication or cognitive difficulties.
AB - Objective: The analysis presented here evaluated the psychometric properties of the Functional Independence Measure (FIM) as a summated rating scale within context of the 20 impairment categories of the FIM-Function Related Group (FIM-FRG) system. Design: This study involved a cross-sectional analysis of patient records, utilizing factor analysis and techniques of multitrait scaling to verify the summative properties of the motor and cognitive dimensions of the FIM and to study the statistical properties of admission FIM scores. Patients: Included were a total of 93,829 patients discharged from 252 freestanding rehabilitation hospitals and units during calendar year 1992. Cases were excluded that had missing or out-of-range values or atypical lengths of stay. These criteria were developed previously in conjunction with an expert clinical panel and confirmed through statistical analyses. Results: Factor analyses supported the motor and cognitive dimensions across all 20 impairment categories. The resulting subscales exceeded minimum criteria for item internal consistency in 96.9% of tests and item discriminant validity in 100% of tests. Reliability coefficients for each impairment category for both subscales ranged from .86 to .97. There were no major ceiling effects, but patients in certain impairment categories were unable to climb stairs at admission. Conclusion: The psychometric properties of the summated FIM compare favorably to most standardized health measures used in medical practice. Findings provide support for the motor and cognitive subscales as used in the FIM-FRGs. As a unidimensional scale, the FIM quantifies care burden. Split into the motor and cognitive (as used in the FIM-FRGs) it distinguishes physical disabilities from those arising from communication or cognitive difficulties.
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U2 - 10.1016/S0003-9993(96)90130-6
DO - 10.1016/S0003-9993(96)90130-6
M3 - Article
C2 - 8931518
AN - SCOPUS:0029914101
SN - 0003-9993
VL - 77
SP - 1101
EP - 1108
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 11
ER -