functional independence measure scoring in the Management of traumatic brain injury among stroke survivors

Ingrid Nilsson; L. Berg; B. Lindqvist

doi:10.5281/zenodo.22815056

Authors

Ingrid Nilsson Division of Rehabilitation Research, Euphrates Research Center for Rehabilitation Research Author https://orcid.org/2794-4120-5632-2668
L. Berg Department of Physical Medicine, Neva Institute of Rehabilitation Research Author https://orcid.org/2422-2497-4374-1543
B. Lindqvist Department of Clinical Rehabilitation Research, Neva Institute of Rehabilitation Research Author https://orcid.org/1367-4499-0781-4255

DOI:

https://doi.org/10.5281/zenodo.22815056

Keywords:

Functional Independence Measure, traumatic brain injury, stroke rehabilitation, outcome measurement, cognitive impairment

Abstract

Graphical abstract

Background: The Functional Independence Measure (FIM) is a widely used ordinal instrument for quantifying functional independence during inpatient rehabilitation, combining motor and cognitive subscales into an 18-item, 7-level score used to guide clinical decisions and benchmarking.

Objective: This review synthesizes the psychometric evidence for FIM scoring and its performance in traumatic brain injury (TBI) rehabilitation and stroke rehabilitation, with attention to stroke survivors whose presentation includes a TBI-like cognitive component.

Methods: We synthesized peer-reviewed reliability and validity studies, comparisons against the Barthel Index, and outcome studies relating FIM scores to rehabilitation intensity, care setting, and discharge disposition.

Findings: FIM motor items show high interrater reliability and predict discharge disposition and caregiver burden well, while cognitive items show lower reliability and ceiling effects that understate residual disability in higher-functioning TBI and TBI-pattern stroke survivors; responsiveness is broadly comparable to the Barthel Index for self-care domains.

Conclusions: FIM scoring remains a practical, reasonably reliable tool for tracking rehabilitation progress in stroke survivors with TBI-pattern disability when motor and cognitive subscales are reported separately and supplemented by instruments extending measurement into higher-level cognitive domains.

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