Original Functional Independence Measure (FIM)
The FIM is a well-validated global measure of disability that is widely used in the developed world.
- It was originally developed in the 1980’s by a task force consisting of American Congress Rehabilitation Medicine, American Academy Physical Medicine and State University NY, Buffalo.
Original US Functional Assessment Measure (US FAM)
- The original Functional Assessment Measure (FAM) items were developed by Santa Clara Valley Medical centre in 1992, but they are no longer maintained in the US.
Development of the UK Functional Assessment Measure (UK FIM+FAM)
- The UK FIM+FAM was first developed 1996 but it has continued to develop during the ensuing 10-15 years.
- As other countries expressed interest, it was adapted to align with the rest of the world.
- The original US FAM items are no longer maintained, but the UK FIM+FAM continues through UK ROC and is increasingly used in other countries.
Key differences between the UK and US versions
The main differences between the original US and UK versions are as follows:
- The language was translated into UK English.
- Some of the more subjective psychosocial items were adjusted to make them easier to score.
- Additional training tools were developed.
Source references
- Turner-Stokes L, Nyein K, Turner-Stokes T, Gatehouse C. The UK FIM+FAM: development and evaluation. Functional Assessment Measure Clinical Rehabilitation 1999; 13(4): 277-287
- Turner-Stokes L, Siegert RJ. A comprehensive psychometric evaluation of the UK FIM+FAM. Disability Rehabilitation 2013; 35(22): 1885-1895
Extended Activities of Daily Living (EADLs)
The EADL was developed as an extension of the FIM+FAM to assess preparation for independent home-based living, or as a standalone tool for community rehabilitation
Source reference
- Law J, Fielding B, Jackson D, Turner-Stokes L. The UK FIM+FAM Extended Activities of Daily Living module: evaluation of scoring accuracy and reliability. Informa Healthcare. 2008 Nov; 1-6
Licensing and accreditation
- From version 5 onward, the FIMÔ has been developed and maintained by Uniform Data Systems (UDS) and its use is restricted by licence
- However, the UK FIM+FAM incorporates version 4 of the FIM which predates the UDS licence restrictions. Permission was obtained from the original FIM developers to use version 4 in the context of the UK FIM+FAM within the UK ROC registry
Formal accreditation is not required although training is recommended.
Guidelines and manual
Further information about the UK FIM+FAM tool and manual are also available as hard copies:
Self-Learning
The following self-learning slides are feely available to assist with tool completion:
Part 1 of 4 General overview
Part 2 of 4 Motor items
Part 3 of 4 Cognitive items
Part 4 of 4 EADL items
Training
UK ROC provides formal training in the use of the UK FIM+FAM. Training sessions are provided annually.
For further information on the date of the next course, please contact the UK ROC team – LNWH-tr.ukroc@nhs.net
Additional References
Find out more about additional reference on PURE.
Using the UK FIM+FAM
The UK FIM+FAM has been used extensively to demonstrate outcomes in the brain injured population. The use of the radar graphs provides a graphical example of differences between the various aetiology of brain injury e.g. trauma, hypoxic brain injury, stroke etc.
More recently, the UK FIM+FAM has been used to provide cut-off points within the prolonged disorder of consciousness population.
Key publications
- Nayar M, Vanderstay R, Sieger RJ, Turner-Stokes L. The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation following a Stroke, from the National UK Clinical Dataset. PLoS One 2016; 11(1): e0147288
- Turner-Stokes L, Rose H, Knight A, Williams H, Siegert RJ, Ashford S. Prolonged disorders of consciousness: identification using the UK FIM+FAM and cohort analysis of outcomes from a UK national clinical database. Disability and Rehabilitation 2022; doi.org/10.1080/09638288.2022.2037754
Derivation of Barthel Index from the FIM+FAM
The UK ROC software also includes an algorithm for automatic derivation of the Barthel Index from the UK FIM+FAM assessments.
- Nyein K, McMichael L, Turner-Stokes L. Can a Barthel score be derived from FIM? Clinical Rehabilitation. 199; 13 (1): 56-63
Whilst the UK FIM+FAM tool was designed for use within UK Specialist Neurorehabilitation Settings, it has also been used in other settings in the UK.
Other countries have shown interest in translating the UK FIM+FAM for local use.
Those wishing to do this should consider whether licensing restrictions apply in their own country.
- The FAM items do not have any restrictions in terms of license, translation, or use.
- From version 5 onwards, the FIM™ is restricted by license with Uniform Data Systems in the US.
- In the UK, FIM v 4 can be used as part of the UK FIM+FAM within the UK ROC registry, but permission to use this outside of the UK cannot be granted by UK ROC.