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The functional independence measure: Tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories,☆☆,,★★

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Abstract

Objective: The analysis presented here evaluated the psychometric properties of the Functional Independence Measure (FIM) as a summated rating scale within context of the 20 impairment categories of the FIM-Function Related Group (FIM-FRG) system.

Design: This study involved a cross-sectional analysis of patient records, utilizing factor analysis and techniques of multitrait scaling to verify the summative properties of the motor and cognitive dimensions of the FIM and to study the statistical properties of admission FIM scores.

Patients: Included were a total of 93,829 patients discharged from 252 freestanding rehabilitation hospitals and units during calendar year 1992. Cases were excluded that had missing or out-of-range values or atypical lengths of stay. These criteria were developed previously in conjunction with an expert clinical panel and confirmed through statistical analyses.

Results: Factor analyses supported the motor and cognitive dimensions across all 20 impairment categories. The resulting subscales exceeded minimum criteria for item internal consistency in 96.9% of tests and item discriminant validity in 100% of tests. Reliability coefficients for each impairment category for both subscales ranged from .86 to .97. There were no major ceiling effects, but patients in certain impairment categories were unable to climb stairs at admission.

Conclusion: The psychometric properties of the summated

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Supported in part by National Institutes of Health grant KO8-AG00487 from the National Institute on Aging and Agency for Health Care Policy and Research grant RO1-HS07595.

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The opinions and conclusions of the authors are not necessarily those of the sponsoring agencies.

UDSmrSM is a service mark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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Dr. Ottenbacher is now associated with the University of Texas School of Allied Health Science, Galveston.