Live Syllabus

DEFINITION:

The FIM is a measure of disability. It is intended to measure what the person with the disability actually does, not what he or she ought to be able to do, or might be able to do if certain circumstances were different.

FIM data are to be collected according to the current (4/1/04) IRF-PAI coding instructions IRF-PAI Coding Instructions: 4/1/2004 version (http://www.udsmr.org/pdfs/irfpaimanual040104%20(1).pdf ) , supplemented by any further instructions in your syllabus. Information about the FIM can be found in the IRF-PAI manual in section III, pages 40-57, Appendix H, and pages 29-34. A copy of the FIM-related sections of this manual should be in your syllabus, in Appendix A. If it is not possible for your Center to follow the correct manual, notify the TBINDC.

Information about the FIM is available from COMBI at these two links: Introduction (COMBI) (http://www.tbims.org/combi/FIM/index.html); Background (COMBI) (http://www.tbims.org/combi/FIM/fimbg.html).

* IRF-PAI instructions used between 1/2002 and 4/2004 (http://www.cms.hhs.gov/InpatientRehabFacPPS/downloads/irfpai-manualint.pdf).
* Summary of the differences between the 4/2004 instructions and the 1/2002 instructions (http://www.cms.hhs.gov/InpatientRehabFacPPS/downloads/irfpai-manual040104.pdf).

CODE:

7 Complete Independence (Timely, Safely)
6 Modified Independence (Extra time, device)
5 Supervision
4 Minimal Assist (subject does 75% *or more of task)
3 Moderate Assist (50 - 74% of task)
2 Maximal Assist (25 - 49% of task)
1 Total Assist (subject does less than 25% of task)
8 Not due this year [Code no longer used; data now collected in all follow-up years.]
9 Unknown

Items 8b and 9b
7 No accidents
6 No accidents, uses devise (catheter, ostomy)
5 One accident in the past 7 days
4 Two accidents in the past 7 days
3 Three accidents in the past 7 days
2 Four accidents in the past 7 days
1 Five or more accidents in the past 7 days
8 Not due this year [Code no longer used; data now collected in all follow-up years.]
9 Unknown - assessment not done
66 Variable did not exist

Item 14: Primary mode of locomotion
w Walking
c Wheelchair
8 Not due this year [Code no longer used; data now collected in all follow-up years.]
9 Unknown

Item 17: Primary mode of comprehension
a Auditory comprehension *more than50% of the time
v Visual comprehension *more than 50% of the time
b Both used equally
8 Not due this year [Code no longer used; data now collected in all follow-up years.]
9 Unknown

Item 18: Primary mode of expression
v Verbal expression *more than 50% of the time
n Nonverbal expression *more than 50% of the time
b Both used equally
8 Not due this year [Code no longer used; data now collected in all follow-up years.]
9 Unknown

NOTE:

All FIM items must be scored. Record what patient actually does. Every effort should be made to obtain the FIM assessments, however, if any items are not assessed, use code 9. Do not leave blanks.

According to the UDS Procedures for Scoring the FIM, "if the subject would be put at risk for injury if tested or does not perform the activity, enter 1". Use this same rule for the TBI Model Systems FIM data collection.

If at follow-up evaluation, patient is walking AND using a wheelchair, code 14 (mode) as the more frequently used mode of locomotion. Do not use the code "b=Both" (as is indicated by UDS instructions). Use all sources of information to determine the more frequent mode of locomotion at the time of evaluation and code either "w" or "c" as appropriate. If more frequent mode of locomotion cannot be determined, code "9".

For #8 (Bladder Management), if patient does not void (e.g., renal failure and on hemodialysis), assign code "7=Complete independence".

According to new FIM instructions (effective 1/1/02), all FIM items now have an "assessment time period". The person's score on a given FIM item is determined by his/her functional level during this "assessment time period"--a specified number of days prior to the evaluation. (FIM instructions prior to 1/1/02 did not indicate an assessment time period.) The assessment time period for all FIM items (except 8b and 9b-see below) is 3 days. Scoring reflects the patient's poorest (most dependent) functioning during the assessment time period1. The evaluation is therefore not a snap-shot of the patient's performance at the time of evaluation, but a summary of performance over the entire assessment time period.

Wearing of eyeglasses causes Comprehension to be scored "6" only if the person's primary form of comprehension is visual (rather than auditory, which is usually primary).

"Level of assistance" (part a) and "Frequency of accidents" (part b) are recorded for #8 (Bladder Management) and #9 (Bowel Management). For items 8b and 9b, the assessment time period is 7 days-that is, the number of accidents is counted across the 7 days prior to the patient's FIM evaluation. If information is not available from the entire 7-day period, then record over the number of days (at least the 3 days prior to evaluation) for which information is available. No adjustment in scoring is made when the when the assessment time period is shorter than 7 days.

See: Properties of the FIM instrument (COMBI) (http://www.tbims.org/combi/FIM/fimprop.html)

1 However, the current training manual qualifies this, as follows: "The patient's score on measures of function should not reflect arbitrary limitations or circumstances imposed by the facility. For example, a patient who can routinely ambulate more than 150 feet throughout the day with supervision (score of 5 for FIM Locomotion: Walk/Wheelchair item), but who is observed to ambulate only 20 feet at night to use the toilet because that is the distance from his/her bed, should receive a Walk score of 5 rather than a lower score" (IRF-PAI Training Manual 1/16/02, page III-4).

EXAMPLE:

SELF CARE ITEMS:
2 1. Feeding
1 2. Grooming
2 3. Bathing
3 4. Dressing Upper Body
3 5. Dressing Lower Body
2 6. Toileting

SPHINCTER CONTROL:
4 8. Bladder Management
4 a. Level of assistance
5 b. Frequency of accidents
5 9. Bowel Management
6 a. Level of assistance
5 b. Frequency of accidents

MOBILITY ITEMS
Transfers technique:
3 10. Bed, Chair, Wheelchair
4 11. Toilet
3 12. Tub or Shower

Locomotion:
3 14. Walking/Wheelchair (1/2/9)
3 15. Stairs

COMMUNICATIONS:
7 17. Comprehension (1/2/3/9)
6 18. Expression (1/2/3/9)

PSYCHOSOCIAL ADJUSTMENT ITEMS:
6 22. Social Interaction

COGNITIVE FUNCTION:
5 26. Problem Solving
4 27. Memory