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Subject of the scale: Physical and cognitive disability

Functional Independance Measure (FIM)


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Composite scale, in questionnaire form, initially written in English and widely used since the 1980s because of its simplicity. It evaluates the level of disability and the functional impact of a given pathology.

The FIM is constituted of 18 items which measure the patient's performance in activities of daily living, including cognitive and social domains.

It appears necessary that medical and paramedical staff undergo one hour of training on the use of the scale.

The scale takes about 30 minutes to administer.

For each item (from 1 to 18), the therapist chooses the patient's level of disability from 1 (total assistance) to 7 (total independence, see the full scale on the page provided).

The total score is calculated by summing the scores for the level of disability for each item.

Interpretation: The lower the score, the greater the disability.

> Access to the scale is not free
Author: UDSMR (non-profitable organisation, affiliated to the University of Buffalo, New York State, USA). Dr. Carl V. Granger is the Executive Director of the UDSMR and of the research centre for functional assessment (creator of the FIM).

Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity


Predictive validity


Construct validity

Convergent validity

[4] [6] [7]

Divergent validity


Discriminant validity
(sensitivity and distinctiveness)



Intra-rater reliability


Inter-rater reliability

[3] [4] [5] [6] [7]



Internal consistency (alpha)



[2] [8]

General comment on reliability:

This scale has been evaluated in many situations and pathologies; Stroke, Spinal Cord Injury, Brain Injury, Multiple Sclerosis, Orthopaedic pathologies (low back pain etc.), Geriatrics. Many teams, particularly for the French language version, have taken an interest in the relevance of the use of this scale and particular its global score as being predictive of a state of health, reflecting its prognostic value. In fact, the global score does not seem to capable of interpretation from one patient to another, not presenting the same deficiencies as the values of the under-scores representing very different inabilities can give rise, after addition, to the same global score and therefore not at all the same difficulties as in everyday life. It is on the other hand useful for dealing with a given patient. The isolated utilisation of certain under-scores can prove to be relevant.

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More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. François GENET :


Inaugural references:

[1] Granger CV, Hamilton BB, Keith RA, Zielezny M, Sherwin FS (1986). Advances in functional assessment for medical rehabilitation. Topics in Geriatric Rehabilitation 1:59-74.

Psychometric references:

[2] Van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the functional independence measure. J Neurol Neurosurg Psychiatry. 1999;66:480–484..

[3] Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: A quantitative review. Arch Phys Med Rehabil. 1996;77:1226-1232.

[4] Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, Thompson AJ. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil. 1995 Jan;17(1):10-4.

[5] Dickson HG, Kohler F. Interrater reliability of the 7-level functional independence measure (fim). Scand J Rehabil Med. 1995;27:253-256.

[6] Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (fim). Scand J Rehabil Med. 1994;26:115-119.

[7] Brosseau L, Wolson C, Daoust J. The interrater reliability and construct validity of the functional independence measure (FIM) for multiple sclerosis subjects. Clin Rehabil. 1994;8:107-115.

[8] Granger CV, Hamilton BB. Uds report. The uniform data system for medical rehabilitation report of first admissions for 1990. Am J Phys Med Rehabil. 1992;71:108-113

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