The current version of the UK FIM+FAM is 2.2, and is available for free download here:
For the UK ROC software & user-guide, please contact LNWH-tr.ukroc@nhs.net.
The UK FIM+FAM contains 30 items; 16 Motor and 14 Cognitive
Each item is scored on a scale of 1-7 where:
- 1 indicates ‘total dependence’ on other people for assistance and
- 7 indicates ‘complete independence’.
The total score range is 30-210.
Usually reported in two main subscales (see page 77 of manual)
- FAM Motor subscale (16 items) score range 16-112.
- FAM cognitive scale (14 items) score range 14-98.
Broad overview of scoring structure
Below is an overview of the 7-level scoring structure which is broadly reproduced for all items, although there are subtle differences, so users are advised to refer to the scoring manual.
A decision tree is provided for each item to aid scoring.
|
Score
|
Brief description
|
|
No help required from another person
|
|
7
|
Fully Independent – completes task safely without any help or equipment
|
|
6
|
Independent with device – or consideration for time or safety
|
|
Help required from another person
|
|
5
|
Supervision or set-up only – no hands-on assistance
|
|
4
|
Minimal assistance – incidental hands-on help only
|
|
3
|
Moderate assistance – but still completes more than half the task themselves
|
|
2
|
Maximal assistance - contributes to task, but helper does more than half the effort
|
|
1
|
Total assistance - unable to do task, or contributes <25% - of 2 helps required
|
Key scoring principles:
- Scores reflect “what the person actually does” not “what they could/should or might do”.
- Ideally the tool should be rated by the multi-disciplinary treating team to provide a holistic view of ability, which may vary throughout the day or between different disciplines.
- If differences are apparent, the lower score is used.
- All items must be scored using the ordinal scoring system of 1-7, referring to the level descriptors in the scoring manual. Half scores (eg 6.5) or not applicable (n/a) are not valid.
- If the activity has not been assessed, then a score of 1 should be assigned.
- The only item that can be scored as 0 is “Wheelchair mobility” – this is only applied if the person does not have and never needs to use a wheelchair.
The UK FIM+FAM can be used in any setting to provide a global assessment of physical, cognitive, communication and psychosocial function.
Within the mandated UK ROC dataset for specialist inpatient rehabilitation, the tool should be completed on admission and discharge from the rehabilitation programme.
Timescales
- Admission assessment – completed within 7-10 working days following admission
- Discharge assessment (within the last 7 days before discharge)
- Optionally, a ‘goal score’ can also be set during the admission assessment, to reflect the therapy teams predicted outcome scores for the programme
These timescales are allowed because it takes time for the team to observe the patient in all the areas of function covered by the tool
FAM splats
The radar chart (or “FAM splat”) provides a graphic representation of the disability profile from the FIM+FAM data (see Fig 1 for example).
- The 30 scale items are arranged as spokes of a wheel. Scoring levels from 1 (total dependence) to 7 (total independence) run from the centre outwards. Thus, a perfect score would be demonstrated as a large circle.
- The yellow shaded portion represents the median scores on admission for each item.
- The blue-shaded area represents the change in median score from admission to discharge.
Figure 1: FAM splat
Extended Activities of Daily Living (EADLs)
A further six items are included as EADLs.
They include the basic skills require to manage independently in a home living environment, including
- meal preparation, housework, laundry, shopping, finance management, and work.
These are optional items, and are more relevant to community rehabilitation or preparation for independent home-based living
- A score of 1 can be assigned if not assessed or therapy is not planned for these items – for example if the patient will always be dependent on nursing home or institutional care.
Neurological Impairment Set (NIS)
The NIS is described elsewhere but should also be completed at the same time as the UK FIM+FAM assessment as it provides a minimum dataset of the impairments that underlie the individual’s functional disability.