What the FIM measures
The FIM shows how much help a person needs from another person or a device to do basic daily activities. It was developed in the United States as part of a uniform data system for medical rehabilitation and is used widely in Australia, especially in inpatient rehabilitation after a stroke, brain injury, spinal cord injury, amputation or major orthopaedic surgery.
It is a measure of what a person actually does, not what they might be able to do. That makes it a good way to track change during rehabilitation.
The 18 items
The FIM has 13 motor items and 5 cognitive items:
- Self care: eating, grooming, bathing, dressing the upper body, dressing the lower body, toileting
- Sphincter control: bladder management, bowel management
- Transfers: bed, chair or wheelchair; toilet; tub or shower
- Locomotion: walking or using a wheelchair; stairs
- Communication: comprehension, expression
- Social cognition: social interaction, problem solving, memory
How FIM scoring works
Each item is rated on a seven point scale. A score of 7 means complete independence, done safely and in a reasonable time. A score of 1 means total assistance, where the person does less than a quarter of the task. Scores in between show whether a device, supervision or hands on help is needed, and how much.
Adding the items gives a total from 18 to 126, often reported as a motor score (13 to 91) and a cognitive score (5 to 35). The change between admission and discharge is a key rehabilitation outcome.
FIM+FAM and WeeFIM
The Functional Assessment Measure (FAM) adds 12 items to the FIM, mostly about thinking, behaviour, communication and community skills, such as emotional status, safety judgement and community access. Together they are called the FIM+FAM and are often used after brain injury, where the FIM alone can miss cognitive and psychosocial needs.
The WeeFIM is the children's version, used from 6 months to 18 years. It has the same 18 item structure and scoring range.
Who can score the FIM
In Australia and New Zealand, the Australasian Rehabilitation Outcomes Centre (AROC) at the University of Wollongong holds the licence for the FIM and WeeFIM. Clinicians who use it are trained and must pass a credentialing exam every two years. Most are nurses, physiotherapists and occupational therapists working in rehabilitation units.
How FIM scores help with the NDIS
The FIM is not one of the NDIA's named preferred tools. For acquired brain injury the NDIA prefers the Care and Needs Scale (CANS), then the WHODAS 2.0, and for spinal cord injury the level of lesion, the ASIA Impairment Scale and the WHODAS 2.0. But FIM scores from your rehabilitation discharge summary are still useful evidence, because they show your level of independence when you left hospital.
If you are applying to the NDIS after a hospital stay, ask your rehabilitation team for your discharge FIM or FIM+FAM scores, a summary of what help you need, and whether they can complete the NDIA's preferred tools before you leave. Keep in mind that your function may keep changing after discharge, so newer evidence may be needed later.
Limits of the FIM
- It focuses on basic daily activities, not community life, work or complex household tasks
- Ceiling effects: many people score near the top yet still need support in the community
- Cognitive items are limited, which is why the FAM was added
- It measures what someone does in a hospital setting, which can differ from life at home