Introduction to the Functional Assessment Measure

Functional Independence Measure (FIM)
The FIM is an 18-item, seven level ordinal scale. It is the product of an effort to resolve the long standing problem of lack of uniform measurement and data on disability and rehabilitation outcomes. The FIM emerged from a thorough developmental process overseen by a National Task Force of rehabilitation research. The National Task force reviewed 36 published and unpublished functional assessment scales before agreeing on an instrument. Subsequent evaluation of the metric properties of the FIM have been reported extensively.

The Uniform Data System for Medical Rehabilitation (UDS) provides training materials, a shared database for participating facilities, and requires overall 80% accuracy of raters at each facility for qualifying members. There is a membership fee.

The FIM was intended to be sensitive to change in an individual over the course of a comprehensive inpatient medical rehabilitation program. The FIM can be completed in approximately 20-30 minutes in conference, by observation, or by telephone interview. Rasch analysis defines two FIM dimensions, labeled motor and cognitive. It was designed to assess areas of dysfunction in activities which commonly occur in individuals with any progressive, reversible or fixed neurologic, musculoskeletal and other disorders. One limitation relative to using the FIM in evaluating survivors of TBI is that it is not diagnosis specific. Although found to be reliable and valid, the scale has few cognitive, behavioral, and communication related functional items relevant to assessing persons with TBI.

Functional Assessment Measure (FAM)
The FAM items were developed by clinicians representing each of the disciplines in an inpatient rehabilitation program. The FAM was developed as an adjunct to the FIM to specifically address the major functional areas that are relatively less emphasized in the FIM, including cognitive, behavioral, communication and community functioning measures. The FAM consists of 12 items. These items do not stand alone, but are intended to be added to the 18 items of the FIM. The total 30 item scale combination is referred to as the FIM+FAM. The time required to administer the FIM+FAM is approximately 35 minutes.

The UK FAM
In 1995 a United Kingdom FIM+FAM users group set out to develop a UK version of the FAM, keeping the 7-level structure, but attempting to improve the objectivity of scoring, especially for ten of the more subjective items of the twelve. This work has been undertaken in collaboration with SCVMC. Click here for more information on the UK FAM.

Information regarding the UK FAM was contributed by Dr. Lynne Turner Stokes. Please contact Dr. Lynne Turner Stokes at lynne.turner-stokes@dial.pipex.com for more information.

Information regarding the FAM was contributed by Santa Clara Valley Medical Center. Please contact Jerry Wright at for more information.

If you find the information in the COMBI useful, please mention it when citing sources of information. The information on the Functional Assessment Measure may be cited as:

Wright, J. (2000). The Functional Assessment Measure. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/FAM ( accessed ).*

*Note: This citation is for the COMBI web material. Mr. Wright is not the scale author for the FAM.