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Functional Independence Measure (FIM)
Note: The FIM is a proprietary instrument. Formal training is required for clinical use and coding. This tool is for educational reference.
Score 18 Items (1-7)
Self-Care
Motor Subscale
Eating
Grooming
Bathing
Dressing (Upper Body)
Dressing (Lower Body)
Toileting
Sphincter Control
Motor Subscale
Bladder Management
Bowel Management
Transfers
Motor Subscale
Bed, Chair, Wheelchair
Toilet
Tub / Shower
Locomotion
Motor Subscale
Walk / Wheelchair
Stairs
Communication (Cognitive)
Cognitive Subscale
Comprehension
Expression
Social Cognition (Cognitive)
Cognitive Subscale
Social Interaction
Problem Solving
Memory
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Standardised assessment of disability severity in inpatient rehabilitation settings.
Tracking progress during rehabilitation for stroke, brain injury, spinal cord injury, and orthopaedic conditions.
Determining the burden of care required post-discharge.
Comprehensive Evaluation
Unlike the Barthel Index which only measures physical ADLs, the FIM includes a 5-item cognitive subscale (communication and social cognition), making it superior for patients with stroke or traumatic brain injury.
Section 2
Formula & Logic
Scoring
18 items total (13 motor, 5 cognitive).
Each item scored 1 to 7 based on level of independence.
Total score: 18 (Total assistance) to 126 (Complete independence).
7-Level Scoring System
7
Complete Independence (Timely, safely)
6
Modified Independence (Device used, > normal time, safety risk)
5
Supervision / Setup (Cuing, coaxing, no physical contact)
4
Minimal Assistance (Patient expends ≥ 75% of effort)
3
Moderate Assistance (Patient expends 50-74% of effort)
2
Maximal Assistance (Patient expends 25-49% of effort)
1
Total Assistance (Patient expends < 25% of effort or 2+ helpers needed)
Section 3
Pearls/Pitfalls
Proprietary Note
The FIM instrument is proprietary and requires formal training and certification for official clinical use and billing (via UDSMR). The tool provided here is for educational and clinical reference only.
Section 4
Next Steps
Care Planning
Section 5
Evidence Appraisal
Primary Reference
The functional independence measure: a new tool for rehabilitation.
Keith RA et al. • Adv Clin Rehabil.. 1987;1:6-18. Initial description of the FIM and the Uniform Data System for Medical Rehabilitation.
Section 6
Origins
Uniform Data System for Medical Rehabilitation
Developed in 1987 by a task force sponsored by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. It was created to provide a uniform, universal measurement system for disability and rehabilitation outcomes.
