FIM

Definition

The FIM instrument 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. It is to be completed based on assessment over 3 calendar days for each assessment period.

FIM instrument data are to be collected according to the current (10/01/2012) IRF-PAI coding instructions (see External Links, supplemented by any further instructions in your syllabus). Information about the FIM instrument can be found in the IRF-PAI manual in section III, pages 39-95. If it is not possible for your Center to follow the correct manual, notify the TBINDC.

At Form 1, only Cognitive FIM items are collected.

The rating scale below should be used for each item. The syllabus provides additional detail on the ratings specific to the items.

Ratings should be based on the poorest performance during the 72-hour assessment period.

Rating Scale
7 - Complete Independence (Timely, safely)
6 - Modified Independence (Extra time, device)
5 - Supervision (performs 100%, but needs supervision)
4 - Minimal Assist (>= 75%)
3 - Moderate Assist (50 - 74%)
2 - Maximal Assist (25 - 49%)
1 - Total Assist (< 25%)

Form

[X] Form 1
[X] Form 2

Source

Form 1 - Abstract from FIM form (rehab record)
Form 2 - Interview (participant or proxy)

Details

All FIM items have an “assessment time period”. The assessment time period for all FIM items (except Bladder and Bowel Frequency of Accidents) is 3 days.

Scoring reflects the patient’s poorest (most dependent) functioning during the assessment time period. The evaluation is therefore not a snapshot of the patient’s performance at the time of evaluation, but a summary of performance over the entire assessment time period.

All FIM items must be scored. Record what patient actually does. If FIM assessment cannot be completed within the window of 3 calendar days, it should still reflect the patients’ status within that time period. If this is not possible and the assessments are done out of the window of 3 calendar days, code as “Unknown”. Every effort should be made to obtain the FIM assessments; however, if any items are not assessed, code “Unknown.” Do not leave blanks.

According to the UDS Procedures for Scoring the FIM instrument, “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 instrument data collection.

For Eating, Grooming, Bathing, Dressing Upper and Lower Body, Toileting and Transfers, if activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

The “Unknown” code is specific to the Model Systems and is to be used when the activity was not assessed within the window due to site specific reasons (e.g. therapists were unable to track patient down to assess FIM item.) At discharge, if an item is not assessed because the patient does not perform the activity, (e.g., patient is unable to perform activity due to an illness or other reasons, or it is unsafe for them to perform the activity) it should be coded as a “1-Total Assistance”. If the patient was being evaluated at admission with either of these reasons, the score would be a “0”.

If patient has an intermittent acute care stay during inpatient rehabilitation, use the FIM scores from the first rehabilitation admission and the last definitive discharge. In addition, if a patient has an intermittent stay which is longer than 30 days, it is then considered a system discharge and the discharge date from rehabilitation is the system discharge date and the FIM scores should correspond to that date.

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: Walking/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).

FIM scores may be abstracted from the medical record as long as the notes are specific (e.g. “patient feeding themselves independently”; “patient is unable to ambulate”; “patient needs the assistance of two people for all transfers”).

If a patient expires while in the rehabilitation facility, record a score of Level 1 for all discharge FIM items.

Total admission FIM is calculated using the admission walking score if participant is walking at discharge or the admission wheelchair score if the person is in a wheelchair at discharge.

At follow-up, FIM may be asked of anyone who would know the details of the participant’s functioning in these areas.

Links

FIM Manual - IRF-PAI instructions for FIM data collection
Introduction (COMBI)
Summary of the differences between the 4/2004 instructions and the 1/2002 instructions
FIM Decision Rule
FIM Cognitive Rating Form
Fone FIM for TBIMS * Fone FIM to be used only as a supplement to assist as needed in determining FIM scoring - not as word-for-word administration.

Reference

Uniform Data System for Medical Rehabilitation 232 Parker Hall SUNY South Campus 3435 Main Street Buffalo, New York 14214 3007 (716) 829 2076; FAX (716) 829 2080

The IRF-PAI instructions for the FIM instrument are disseminated through the website of The Centers for Medicare and Medicaid Services. For information about the CMMS, go to: http://www.cms.hhs.gov/researchers/projects/APR/2003/facts.pdf.

©1997 Uniform Data System for Medical Rehabilitation (UDSMR), a division of UB Foundation Activities, Inc. FIM is a trademark of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. This version of the FIM instrument has been modified with permission from UDSMR for use by the Traumatic Brain Injury Model Systems.

Characteristics

12 additional FAM items were collected from 10/01/1989 to 4/01/1998 when the collection of the FAM items became optional. FAM items were removed 7/01/1999.

On 4/1/02 new fields were created to accept data collected with the new (1/1/02) IRF-PAI instructions. The old fields are still in the database. At present there are no calculated variables that merge old data and with new data. Calculated variables based on either old or new scoring are available.

On 10/1/2019, centers began collecting the CARE Item Set at Form 1, and the collection of FIM Motor variables at Form 1 was no longer required. FIM Cognitive variables continue to be collected.

On 7/1/2020, the collection of FIM Motor variables at Form 1 was discontinued.

On 1/15/2025, a new coding rule was implemented: “If all FIM Cognitive items = 7 and FIM Stairs = 7, then remaining FIM items can be skipped and coded as 7.”. FIM Cognitive questions are now asked first, followed by FIM Stairs and the remaining FIM Motor items in the standard FIM order.

Training

Testing and certification of data collectors of this variable is required. Check with your center for their requirements for FIM certification.

ITHealthTrack training and certification materials (DVDs) are available at each local TBIMS center and also on the website under the Training & Certification tab (click on the “Certification” dropdown, then “Certification File Manager”, then “FIM Certification Materials”. Please contact CB Eagye at “PEagye@craighospital.org” for additional training and certification details.

A score of 80% or greater is required for FIM certification.

See external links for ITHealthTrack Exam Instructions and Exam Form.

BATHING

Definition

Bathing includes washing, rinsing, and drying the body from the neck down (excluding the neck and back) in either a tub, shower, or sponge/bed bath. The patient performs the activity safely.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBathF	677	Bathing:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

BED TRANSFER

Definition

Transfers: Bed, Chair, Wheelchair includes all aspects of transferring from a bed to a chair and back, or from a bed to a wheelchair and back, or coming to a standing position if walking is the typical mode of locomotion. The patient performs the activity safely. # Details If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBedTransF	677	Bed, chair, wheelchair transfers:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

BLADDER ACCIDENT

Definition

Bladder Management: Frequency of Accidents – Bladder accidents refers to the act of wetting linen or clothing with urine, and includes bedpan and urinal spills.

Details

For Frequency of Bladder Accidents and Frequency of Bowel Accidents, 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.

For a Bladder or Bowel Management score of 6-Modified Independence on the FIM, the patient must be able to manage all aspects of their bladder/bowel care independently and have had no accidents within the last 7 days. An accident is defined by FIM as any soiling of linens or clothing, and if the participant wears a diaper, the bowel movement or urine must be fully contained within the diaper, not soiling clothing or bedding. So if the patient wears a diaper, and they are able to retrieve the diaper, change it , and dispose of it without assistance, AND they have no accidents outside of the diaper then the total Bladder or Bowel Management score would be a 6.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBladAccF	675	Bladder management – frequency of accidents:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
675	1	Five or More Accidents in the Past 7 Days
675	2	Four Accidents in the Past 7 Days
675	3	Three Accidents in the Past 7 Days
675	4	Two Accidents in the Past 7 Days
675	5	One Accident in the Past 7 Days
675	6	No Accidents: Uses device ( Catheter, Ostomy )
675	7	No Accidents
675	66	Variable Did Not Exist
675	88	Not Applicable: Variable not due this year
675	99	Unknown

History

No history found for the Domain.

BLADDER ASSISTANCE

Definition

Bladder Management - Level of Assistance includes the safe use of equipment or agents for bladder management.

Details

For a Bladder or Bowel Management score of 6-Modified Independence on the FIM, the patient must be able to manage all aspects of their bladder/bowel care independently and have had no accidents within the last 7 days. An accident is defined by FIM as any soiling of linens or clothing, and if the participant wears a diaper, the bowel movement or urine must be fully contained within the diaper, not soiling clothing or bedding. So if the patient wears a diaper, and they are able to retrieve the diaper, change it , and dispose of it without assistance, AND they have no accidents outside of the diaper then the total Bladder or Bowel Management score would be a 6.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBladAsstF	677	Bladder management – level of assistance:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

BLADDER MANAGEMENT

Definition

Bladder Management includes complete and intentional control of the urinary bladder and, if necessary, use of equipment or agents for bladder control.

Bladder Management equals the lower score from Bladder Management: Level of Assistance and Bladder Management: Frequency of Accidents.

Details

For Bladder Management, if patient does not void (e.g., renal failure and on hemodialysis), assign code “7. Complete Independence”.

For a Bladder or Bowel Management score of 6-Modified Independence on the FIM, the patient must be able to manage all aspects of their bladder/bowel care independently and have had no accidents within the last 7 days. An accident is defined by FIM as any soiling of linens or clothing, and if the participant wears a diaper, the bowel movement or urine must be fully contained within the diaper, not soiling clothing or bedding. So if the patient wears a diaper, and they are able to retrieve the diaper, change it , and dispose of it without assistance, AND they have no accidents outside of the diaper then the total Bladder or Bowel Management score would be a 6.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBladMgtF	677	Bladder management:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

Date	Description
2013-04-01	Added NOTE: how to code if participant wears a diaper.

BOWEL ACCIDENT

Definition

Bowel Management - Frequency of Accidents - Bowel accidents refer to the act of soiling linen or clothing with stool, and includes bedpan spills.

Details

For Frequency of Bladder Accidents and Frequency of Bowel Accidents, 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. Because the admission FIM evaluation must be done at the end of the first 3 days after rehab admission, the assessment time period therefore includes the 4 days prior to rehab admission. If information is not available from this 4-day period, then treat only the 3 days after rehab admission as the assessment time period. No adjustment in scoring of items Bladder and Bowel Frequency of Accidents is made when the assessment time period is shorter than 7 days.

For a Bladder or Bowel Management score of 6-Modified Independence on the FIM, the patient must be able to manage all aspects of their bladder/bowel care independently and have had no accidents within the last 7 days. An accident is defined by FIM as any soiling of linens or clothing, and if the participant wears a diaper, the bowel movement or urine must be fully contained within the diaper, not soiling clothing or bedding. So if the patient wears a diaper, and they are able to retrieve the diaper, change it , and dispose of it without assistance, AND they have no accidents outside of the diaper then the total Bladder or Bowel Management score would be a 6.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBwlAccF	675	Bowel management – frequency of accidents:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
675	1	Five or More Accidents in the Past 7 Days
675	2	Four Accidents in the Past 7 Days
675	3	Three Accidents in the Past 7 Days
675	4	Two Accidents in the Past 7 Days
675	5	One Accident in the Past 7 Days
675	6	No Accidents: Uses device ( Catheter, Ostomy )
675	7	No Accidents
675	66	Variable Did Not Exist
675	88	Not Applicable: Variable not due this year
675	99	Unknown

History

Date	Description
2013-04-01	Added NOTE: how to code if participant wears a diaper.

BOWEL ASSISTANCE

Definition

Bowel Management - Level of Assistance includes use of equipment or agents for bowel management.

Details

For a Bladder or Bowel Management score of 6-Modified Independence on the FIM, the patient must be able to manage all aspects of their bladder/bowel care independently and have had no accidents within the last 7 days. An accident is defined by FIM as any soiling of linens or clothing, and if the participant wears a diaper, the bowel movement or urine must be fully contained within the diaper, not soiling clothing or bedding. So if the patient wears a diaper, and they are able to retrieve the diaper, change it , and dispose of it without assistance, AND they have no accidents outside of the diaper then the total Bladder or Bowel Management score would be a 6.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBwlAsstF	677	Bowel management – level of assistance:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

BOWEL MANAGEMENT

Definition

Bowel Management includes complete and intentional control of bowel movements and, if necessary, use of equipment or agents for bowel control.

Bowel Management equals the lower score from Bowel Management: Level of Assistance and Bowel Management: Frequency of Accidents.

Details

For Frequency of Bladder Accidents and Frequency of Bowel Accidents, 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. Because the admission FIM evaluation must be done at the end of the first 3 days after rehab admission, the assessment time period therefore includes the 4 days prior to rehab admission. If information is not available from this 4-day period, then treat only the 3 days after rehab admission as the assessment time period. No adjustment in scoring of items Bladder and Bowel Frequency of Accidents is made when the assessment time period is shorter than 7 days.

For a Bladder or Bowel Management score of 6-Modified Independence on the FIM, the patient must be able to manage all aspects of their bladder/bowel care independently and have had no accidents within the last 7 days. An accident is defined by FIM as any soiling of linens or clothing, and if the participant wears a diaper, the bowel movement or urine must be fully contained within the diaper, not soiling clothing or bedding. So if the patient wears a diaper, and they are able to retrieve the diaper, change it, and dispose of it without assistance, AND they have no accidents outside of the diaper then the total Bladder or Bowel Management score would be a 6.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMBwlMgtF	677	Bowel management:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

COMPREHENSION

Definition

Comprehension includes understanding of either auditory or visual communication (e.g., writing, sign language, gestures).

Details

Comprehension of complex or abstract information includes (but is not limited to ) understanding current events appearing in television programs or newspaper articles, or abstract information on subjects such as religion, humor, math, or finances used in daily living. It may also include understanding information given during a group conversation. Information about basic daily needs refers to conversation, directions, and questions or statements related to the subject’s need for nutrition, fluids, elimination, hygiene or sleep (physiological needs).

7 - No help from another person, extra time, or special equipment needed for either abstract or basic needs
6 - If either: a) takes more time than is reasonable to understand complex and abstract information AND/OR uses any special equipment such as glasses for visual comprehension or a hearing aid for auditory comprehension
5 - Help needed (slowed speech rate, repetition, stressing certain words or phrases, pauses, or visual or gestural cues) to understand directions and conversation about basic daily needs, such as hunger, thirst, or discomfort, only rarely (less than 10% of the time) [Participant understands lengthy instructions most of the time]
4 - ONLY occasional help needed to understand directions and conversation about basic daily needs (about 25% of the time) (Participant understands short sentences)
3 - Understand questions about basic daily needs half or more of the time (Participant understands 2-3 word sentences)
2 - Can understand or respond appropriately and consistently with prompting (one word, one thought at a time)
1 - Unable to understand or responds inappropriately or inconsistently despite prompting (understands VERY little)

NOTE - 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).

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMCompA	490	Comprehension:	1989-10-01 - Variable Added
Form 1	FIMCompD	490	Comprehension:	1989-10-01 - Variable Added
Form 2	FIMCompF	677	Comprehension:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
490	1	Total Assist ( < 25% )
490	2	Maximal Assist ( 25 - 49% )
490	3	Moderate Assist ( 50 - 74% )
490	4	Minimal Assist ( >= 75% )
490	5	Supervision ( 100% )
490	6	Modified Independence ( Extra time, device )
490	7	Complete Independence ( Timely, safely )
490	66	Variable Did Not Exist
490	99	Unknown
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

DRESSING LOWER

Defintition

Dressing – Lower Body includes dressing and undressing from the waist down, as well as applying and removing a prosthesis or orthosis when applicable. The patient performs this activity safely.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMDrsdwnF	677	Dressing lower body:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

DRESSING UPPER

Definition

Dressing – Upper Body includes dressing and undressing above the waist, as well as applying and removing a prosthesis or orthosis when applicable. The patient performs this activity safely.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMDrupF	677	Dressing upper body:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

EATING

Definition

Eating includes the ability to use suitable utensils to bring food to the mouth, as well as the ability to chew and swallow the food once the meal is presented in the customary manner on a table or tray. The patient performs this activity safely.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMFeedF	677	Eating:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

EXPRESSION

Definition

Expression includes clear vocal or non-vocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device.

Details

7 - No help from another person, extra time, or special equipment needed to express complex and abstract ideas, such a family matters, current events or household finances
6 - If either: a) takes more time than is reasonable to express complex and abstract information AND/OR uses any special equipment such augmentative communication system AND/OR has mild difficulty with word-finding problems or mild dysarthria
5 - Help needed such as repetition or prompting to express basic daily needs, such as hunger, thirst or discomfort, only rarely (less than 10% of the time)
4 - ONLY occasional help to express basic daily needs (about 25% of the time)
3 - Express basic daily needs half or more of the time
2 - Can express appropriately and consistently with prompting
1 - Unable to express or expresses inappropriately or inconsistently despite prompting

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMExpressA	490	Expression:	1989-10-01 - Variable Added
Form 1	FIMExpressD	490	Expression:	1989-10-01 - Variable Added
Form 2	FIMExpressF	677	Expression:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
490	1	Total Assist ( < 25% )
490	2	Maximal Assist ( 25 - 49% )
490	3	Moderate Assist ( 50 - 74% )
490	4	Minimal Assist ( >= 75% )
490	5	Supervision ( 100% )
490	6	Modified Independence ( Extra time, device )
490	7	Complete Independence ( Timely, safely )
490	66	Variable Did Not Exist
490	99	Unknown
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

FIM - CALCULATED

FIM Total Scores

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMCOGA	487	FIM Cognitive on Admission:	1989-10-01 - Variable Added
Form 1	FIMCOGD	488	FIM Cognitive at Discharge:	1989-10-01 - Variable Added
Form 1	FIMMOTA	492	FIM Motor on Admission:	1989-10-01 - Variable Added
Form 1	FIMMOTD	493	FIM Motor at Discharge:	1989-10-01 - Variable Added
Form 1	FIMTOTA	494	FIM Total at Admission:	1989-10-01 - Variable Added
Form 1	FIMTOTD	495	FIM Total at Discharge:	1989-10-01 - Variable Added
Form 2	FIMCOGF	676	FIM Cognitive Follow-up:	1989-10-01 - Variable Added
Form 2	FIMMOTF	679	FIM Motor Followup:	1989-10-01 - Variable Added
Form 2	FIMTOTF	680	FIM Total (New) Follow-up:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
487	999	Unknown
488	999	Unknown
492	999	Unknown
493	999	Unknown
494	9999	Unknown
495	9999	Unknown
676	999	Unknown
679	999	Unknown
680	9999	Unknown

History

No history found for the Domain.

GROOMING

Definition

Grooming includes oral care, hair grooming (combing or brushing hair), washing the hands (including rinsing and drying), washing the face (including rinsing and drying) and either shaving the face or applying make-up. If the subject neither shaves nor applies make-up, Grooming includes only the first four tasks. The patient performs this activity safely. This item includes obtaining articles necessary for grooming.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMGroomF	677	Grooming:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

LOCOMOTION MODE

Definition

Locomotion Mode - the more frequent mode of locomotion (walk or wheelchair).

Locomotion: Walk includes walking on a level surface once in a standing position. The patient performs the activity safely.

Locomotion: Wheelchair includes using a wheelchair on a level surface once in a seated position. The patient performs the activity safely.

Details

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: Walking/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).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMLocoF	677	Walking/Wheelchair:	1989-10-01 - Variable Added
Form 2	FIMLocoModeF	678	Walking/Wheelchair – mode:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown
678	w	Walk
678	c	Wheelchair
678	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
678	99	Unknown

History

Date	Description
2004-08-19	Added NOTE: if patient is walking and not using wheelchair, code Wheelchair On Admission as "8. Not Applicable."

MEMORY

Definition

Memory includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Memory in this context includes the ability to store and retrieve information, particularly verbal and visual. The functional evidence of memory includes recognizing people frequently encountered, remembering daily routines, and executing requests without being reminded. A deficit in memory impairs learning as well as performance of tasks.

Details

7 - No help from another person, extra time, or special equipment needed to to remember people, routines and requests
6 - If either: a) has slight difficulty recognizing people, remembering daily routines and carrying out requests without need for repetition AND/OR uses self-initiated or environmental cues, prompts or aids to recognize people, remember daily routines, or to carry out requests
5 - Needs help from another person ONLY rarely to recognize and remember people, daily routines, or to carry out requests(less than 10% of the time)
4 - Need ONLY occasional help to remember people, daily routines, or to carry out requests (about 25% of the time)
3 - Remembers people, routines and requests half or more of the time
2 - Participant remembers 25-50% of time
1 - Participant needs help to remember all of the time or does s/he not effectively recognize and remember (Participant remembers less than 25% or the time)

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMMemA	490	Memory:	1989-10-01 - Variable Added
Form 1	FIMMemD	490	Memory:	1989-10-01 - Variable Added
Form 2	FIMMemF	677	Memory:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
490	1	Total Assist ( < 25% )
490	2	Maximal Assist ( 25 - 49% )
490	3	Moderate Assist ( 50 - 74% )
490	4	Minimal Assist ( >= 75% )
490	5	Supervision ( 100% )
490	6	Modified Independence ( Extra time, device )
490	7	Complete Independence ( Timely, safely )
490	66	Variable Did Not Exist
490	99	Unknown
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

METHOD

Definition

Method used to collect FIM Cognitive items include the following:

1 – assessed by clinical staff following UDS rules
2 – assessed by clinical staff, single administration
3 – abstracted from medical record (e.g., reading clinical notes in the medical record to determine score)
4 – assessed by research staff following UDS rules
5 – assessed by research staff, single administration
6 – assessed by consulting clinical staff
7 – assessed using a mixture of above (describe method in open text field)

Form

[X] Form 1
[ ] Form 2

Source

Form 1 - See code choices for acceptable collection methods

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMMeth	4147	FIM Cognitive Method of Data Collection:	2020-07-01 - Variable Added
Form 1	FIMMethDesc		Description of Method if Multiple Methods Used:	2020-07-01 - Variable Added

Codes and Values

ID	Code	Description
4147	1	Assessed By Clinical Staff Following UDS Rules
4147	2	Assessed By Clinical Staff, Single Administration
4147	3	Abstracted From Medical Record ( (e.g., Reading Clinical Notes In The Medical Record To Determine Score) )
4147	4	Assessed By Research Staff Following UDS Rules
4147	5	Assessed By Research Staff, Single Administration
4147	6	Assessed By Consulting Clinical Staff
4147	7	Assessed Using A Mixture Of Above ( (Describe Method In Open Text Field) )
4147	66	Variable Did Not Exist
4147	88	Not applicable
4147	99	Unknown

History

No history found for the Domain.

PROBLEM SOLVING

Definition

Problem Solving includes skills related to solving problems of daily living. This means making reasonable, safe, and timely decisions regarding financial, social, and personal affairs, as well as the initiation, sequencing, and self-correcting of tasks and activities to solve problems.

Details

7 - No help from another person, extra time, or special equipment needed to solve complex problems like managing a checking account or confronting interpersonal problems
6 - If either: a) takes more time in make appropriate decisions or solve problems AND/OR slight difficulty deciding what to do when a problem arises or initiating and carrying out steps to solve a problem (Participant less confident, more uncertain in making decisions and solving problems)
5 - Help needed to solve routine problems only rarely or only when under stressful conditions (less than 10% of the time) (Participant asks for help)
4 - ONLY occasional help need to solve routine problems effectively (help needed about 25% of the time)
3 - Solves routine problems appropriately half or more of the time
2 - Participant solves routine problems 25-50% of the time
1 - Unable to solve problems, needs constant 1:1 help

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMProbSlvA	490	Problem solving:	1989-10-01 - Variable Added
Form 1	FIMProbSlvD	490	Problem solving:	1989-10-01 - Variable Added
Form 2	FIMProbSlvF	677	Problem solving:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
490	1	Total Assist ( < 25% )
490	2	Maximal Assist ( 25 - 49% )
490	3	Moderate Assist ( 50 - 74% )
490	4	Minimal Assist ( >= 75% )
490	5	Supervision ( 100% )
490	6	Modified Independence ( Extra time, device )
490	7	Complete Independence ( Timely, safely )
490	66	Variable Did Not Exist
490	99	Unknown
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

SOCIAL INTERACTION

Definition

Social Interaction includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one’s own needs together with the needs of others.

Details

Examples of socially inappropriate behaviors include temper tantrums; loud, foul, or abusive language; excessive laughing or crying; physical attack; or very withdrawn or non-interactive behavior.

7 - No help from another person, extra time, or special equipment needed to interact with others in social and therapeutic situations
6 - If either: a) takes more time in social situations AND/OR interacts appropriately only in structured or modified environments AND/OR requires medication for social interaction
5 - Help needed to interact appropriately only rarely or only when under unfamiliar or stressful conditions (less than 10% of the time)
4 - ONLY occasional help need to interact appropriately with others (help needed about 10-25% of the time)
3 - Interacts appropriately half or more of the time (helper stays with them at activity)
2 - Interacts appropriately 25-50% of the time with assistance (helper stays for interaction)
1 - Unable to interact appropriately even with assistance

Variables

Form Type	Variable	ID	Question	History
Form 1	FIMSocialA	490	Social interaction:	1989-10-01 - Variable Added
Form 1	FIMSocialD	490	Social interaction:	1989-10-01 - Variable Added
Form 2	FIMSocialF	677	Social interaction:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
490	1	Total Assist ( < 25% )
490	2	Maximal Assist ( 25 - 49% )
490	3	Moderate Assist ( 50 - 74% )
490	4	Minimal Assist ( >= 75% )
490	5	Supervision ( 100% )
490	6	Modified Independence ( Extra time, device )
490	7	Complete Independence ( Timely, safely )
490	66	Variable Did Not Exist
490	99	Unknown
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

STAIRS

Definition

Locomotion: Stairs includes going up and down 12 to 14 stairs (one flight) indoors in a safe manner.

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMStairsF	677	Stairs:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

TOILET TRANSFER

Definition

Transfers: Toilet includes safely getting on and off a toilet.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMToilTransF	677	Toilet transfers:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

TOILETING

Definition

Toileting includes maintaining perineal hygiene and adjusting clothing before and after using a toilet, commode, bedpan, or urinal. The patient performs this activity safely.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMToiletF	677	Toileting:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.

TUB TRANSFER

Definition

Transfers: Tub/shower includes getting into and out of a tub/shower. The patient performs the activity safely.

Details

If activity is not performed, assign code “1. Total Assist” (do not use the “0” code at follow-up).

Variables

Form Type	Variable	ID	Question	History
Form 2	FIMTubTransF	677	Tub or shower transfers:	1989-10-01 - Variable Added

Codes and Values

ID	Code	Description
677	1	Total Assist ( < 25% )
677	2	Maximal Assist ( 25 - 49% )
677	3	Moderate Assist ( 50 - 74% )
677	4	Minimal Assist ( >= 75% )
677	5	Supervision ( 100% )
677	6	Modified Independence ( Extra time, device )
677	7	Complete Independence ( Timely, safely )
677	66	Variable Did Not Exist
677	88	Not Applicable: Variable not due this year ( Code no longer used; data now collected in all follow-up years )
677	99	Unknown

History

No history found for the Domain.