FIM FAM

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FIMFAM OUTCOME MEASURES

• Presented by Caroline Ray
• On behalf of Queen Elizabeths Foundation Brain
  Injury Centre, Banstead, Surrey.

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FIMFAM A BACKGROUND

• Functional assessment measures have been in use
  for half a century in rehabilitation to plan and
  evaluate care, determine compensation and predict
  prognosis.
• The Barthel Scale (1965), commonly used by
  nursing staff measures activities such as
  feeding, grooming, bathing, dressing, transfers
  and mobility but it does not address
  cognitive/social issues.

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FIMFAM A BACKGROUND

• In the early 1980s an American task force took
  items from existing physical scales and
  developed the Functional Independence Measure
  (FIM).
• This was intended to create a global measure of
  disability but one which additionally addressed
  cognitive/psycho-social issues and which could be
  considered to be reliable regardless of clinical
  background of user.

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FIMFAM A BACKGROUND

• The FIM is an 18 item measurement that evaluates
  a persons functional status and abilities.
  Monitoring of scores therefore reflects progress
  and the clients discharge destination.
• Functional Assessment Measure extends the
  coverage of the FIM and this scale was developed
  in the USA and adapted for the UK in 1993 (last
  modified in 1999).

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FIMFAM UK OUTCOME MEASURE

• It adds an additional 12 items to the FIM which
  are around cognition and tests attention levels,
  problem solving, comprehension, expression,
  memory and social interaction, reading and
  writing skills and employability.
• Status on admission, according to FIMFAM scales,
  provides the clinical baselines and focus for
  treatment. It is recommended that the FIMFAM is
  scored by a multi-disciplinary team, which
  improves inter-rated reliability.

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FIMFAM QEF BIC MODEL

• Levels of dependency in activities of daily
  living, cognitive and communication, literacy and
  emotional adjustment are regularly assessed
  during the students rehabilitation and at
  discharge.
• Assessment Scale runs from 1 - being the
  requirement of total assistance (the individual
  performs less that 25 of the task) to 7 -
  complete independence (the task is completed in a
  timely and safely manner).

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FIMFAM QEF BIC MODEL

• Data collected clearly shows the progress that
  clients make during their rehabilitation from
  which valuable evidence can be extrapolated, for
  example
• 91 of clients have made progress in completing
  personal care, 100 have made progress with
  physical skills while a further 75 of clients
  have made progress with literacy and cognition.

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WHY MEASURE OUTCOMES?

• To convince purchasers of services and
  demonstrate that rehabilitation is effective
• To help direct therapies identify which areas to
  work on
• Encourage team communication and joint working
• Data can be used to compare different services
  and client populations
• Clearly demonstrate progress with physical and
  cognitive abilities and the subsequent reduced
  burden of care

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Further information

• QEF, BIC Contact Head of Clinical Services
  lynne.hensor_at_qef.org.uk
• FIM/FAM training at Northwick Park Hospital,
  Harrow, Middx. Oct. 2011 cost 100 per person.
• FACS (AHSA)
• Assessment to measure functional communication of
  adults with speech, language and cognitive
  communication disorders (including social
  communication, communication of daily needs,
  reading, writing, number concepts and daily
  planning.)