Rehabilitation outcome
Functional Independence Measure (FIM)
The FIM is an 18-item scale scoring how much assistance a person needs across thirteen motor and five cognitive tasks. Each item is scored from 1 (total assistance) to 7 (complete independence), giving a total between 18 and 126. Scored at admission and discharge, the change is a standard measure of rehabilitation effect.
What it measures
The FIM measures burden of care — how much another person has to do for the patient — rather than impairment. That distinction matters: two patients with the same weakness can score very differently depending on how much help they actually need to get through a day.
It covers thirteen motor items (eating, grooming, bathing, dressing upper and lower body, toileting, bladder and bowel management, bed and chair transfers, toilet transfers, shower transfers, walking or wheelchair use, stairs) and five cognitive items (comprehension, expression, social interaction, problem solving, memory).
How it is scored
Each item is scored on a seven-point scale. A score of 1 means the patient performs less than 25% of the task themselves; 7 means complete independence with no aid, no adaptation and no unusual amount of time. Scores between indicate progressively less assistance.
The total is reported alongside the motor and cognitive subscales. Reporting only the total hides the pattern — a patient can gain substantially in motor function while cognitive scores stay flat, and a family needs to know which of the two happened.
How we use it
We score the FIM at admission and again at discharge for every inpatient. The change between the two, together with the number of days between the assessments, is the primary figure we report to patients, families and referring clinicians.
Key facts
| Abbreviation | FIM |
|---|---|
| Number of items | 18 |
| Score range | 18–126 total (13 motor items 13–91; 5 cognitive items 5–35) |
| Time to administer | 30–45 minutes by a credentialed assessor |
| Training required | Yes — formal credentialing is required for scoring consistency |
| Cost | Licensed instrument; fee applies |
| Equipment | No equipment — structured observation of the patient performing the tasks |
| Domains | Self-care · Sphincter control · Transfers · Locomotion · Communication · Social cognition |
| ICF domain | Activity and participation |
| Age range | Adult 18+ (WeeFIM for children) |
| Populations | Stroke · Traumatic brain injury · Spinal cord injury · Multiple sclerosis · Orthopaedic · Amputation |
| Languages | Available in many languages under licence |
Psychometrics by population
The same instrument behaves differently in different conditions. A cut-off established in older adults does not transfer to Parkinson's disease, and a minimal detectable change from one study does not apply to another population.
| Population | Cut-off | MDC / MCID | Reliability | Validity |
|---|---|---|---|---|
| Stroke | — | MCID 22 points for total FIM, 17 for motor and 3 for cognitive (Beninato 2006) | High inter-rater reliability with credentialed assessors | Strong concurrent validity against the Barthel Index |
| Spinal cord injuryThe motor subscale is more responsive than total FIM in this population; the SCIM is often preferred | — | — | — | — |
| Traumatic brain injuryCognitive subscale ceiling effects are reported in milder injury | — | — | — | — |
Things to be careful about
- Ceiling effects limit sensitivity in higher-functioning patients
- Requires credentialed assessors — scores from untrained raters are not comparable
- Motor and cognitive subscales should always be reported separately, not only as a total
Forms and downloads
Functional Independence Measure (FIM) — scoring form
Scoring forms are distributed under licence and cannot be republished here. Ask your rehabilitation team for the version they use.
Availability depends on the instrument's licence.
Frequently asked questions
What is a good FIM score?
There is no single good score. The total runs from 18, where a person needs total assistance with everything, to 126, where they are completely independent. What matters clinically is the change between admission and discharge and the number of days it took, not the figure on its own — a patient who moves from 40 to 70 has gained more than one who arrives at 95 and leaves at 100.
Why is the FIM scored twice?
Once at admission and once at discharge. The difference between the two, set against the number of days between them, is the primary figure we report to patients, families and referring clinicians. A single score describes a moment; only the change describes what rehabilitation did.
Why are the motor and cognitive scores reported separately?
Because the total hides the pattern. A patient can gain substantially in motor function while cognitive scores stay flat, and a family needs to know which of the two happened — the two have very different consequences for going home. We report the 13 motor items and the 5 cognitive items alongside the total, never the total alone.
Can a FIM score from another hospital be compared with ours?
Only if both were scored by credentialed assessors. The FIM requires formal credentialing and scores from untrained raters are not comparable. If you are bringing records from another centre, tell us who performed the assessment — it changes how we read the number.
Is the FIM free to use?
No. It is a licensed instrument and a fee applies, which is one reason the freely available Barthel Index remains so widely used. Scoring forms are distributed under licence and cannot be republished here; ask your rehabilitation team for the version they use.
Sources
- Uniform Data System for Medical Rehabilitation — FIM instrument documentation — UDSMR (2024)
- Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the Functional Independence Measure: a quantitative review — Archives of Physical Medicine and Rehabilitation (1996)
- Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke — Archives of Physical Medicine and Rehabilitation (2006)
Topic
Related instruments
- Daily livingBarthel IndexThe Barthel Index is a ten-item scale of independence in daily activities, scored from 0 to 100 in five-point increments.
- Balance and fallsBerg Balance ScaleThe Berg Balance Scale assesses static and dynamic balance through fourteen everyday tasks, each scored 0 to 4, giving a total out of 56.
- EnduranceSix-minute walk testThe six-minute walk test records the distance a person can walk in six minutes on a flat, measured course.
