The Role of the FIM in Physical Therapy

The Functional Independence Measurement (FIM) is an outcome measurement tool used by physical therapists and other healthcare professionals to measure overall independence during specific functional tasks. It is most often used in acute hospitals and subacute rehabilitation settings, although it can be used anywhere for patients who have functional mobility impairments.

Parts of the FIM

The FIM is composed of 18 specific tasks that are commonly assessed and treated by physical therapists, occupational therapists, nurses, and other rehabilitation professionals. These tasks include activities such as mobility, walking, self-care, and communication.

The FIM is divided into six major categories, with various tasks in each category that are assessed. These categories focus on various functional mobility tasks that you may encounter throughout your day. The categories and sub-categories are as follows.

Self-Care

• Feeding
• Grooming
• Bathing
• Upper body dressing
• Lower body dressing
• Toileting

Sphincter Control

• Bladder management
• Bowel management

Mobility

• Transfer: bed to wheelchair
• Transfer: toilet to wheelchair
• Transfer: tub and shower mobility

Locomotion

• Walking/wheelchair
• Stairs

Communication

• Comprehension
• Expression

Social Cognition

• Social interaction
• Problem-solving
• Memory

Scoring

Each of the 18 items on the FIM is scored by your physical therapist on a scale of one to seven. A score of seven indicates that you are completely independent in that particular activity. A score of one means that you require total assistance for the activity. Therefore, the minimum score on the FIM is 18, and the maximum score is 126, which indicates complete independence.

A complete list of scores for the FIM is as follows:

1. Total assist needed
2. Maximal assist (you can perform 25 percent of the task)
3. Moderate assist (you can perform 50 percent of the task)
4. Minimal assist (you can perform 75 percent of the task)
5. Supervision needed
6. Modified independence (you use an assistive device)
7. Independence in performing the task

Using an outcome tool like the FIM is important for many reasons. First, understanding your current level of safety and functional mobility can help you and your PT set reasonable and attainable rehab goals. Second, your FIM score can be used to measure your personal progress through physical therapy. As you improve with your functional mobility, your FIM score will improve. This also helps your PT gauge your progress and gives credence to what your PT is doing with you in therapy. Your PT may also use your FIM score in while working with other rehab providers like occupational therapists and speech-language pathologists.

Your physical therapist may also use your FIM score to assess your overall safety with mobility. The more assistance you need with a task, the lower your FIM score will be. Your PT can then use that score to assess your overall safety with moving around and functional mobility.

To properly use the FIM, your PT must be certified. This is done through coursework via the Uniform Data System of Medical Rehabilitation (UDSMR). Official FIM forms and information can also be purchased through the UDSMR. Does that mean that the FIM cannot be used at all by your physical therapist? No. But certification does indicate that your therapist is fully trained to apply the outcome measures gained from the FIM. This can ensure that you have a successful rehab experience and outcome.

A Word From Verywell

If you are ever hospitalized, your healthcare team will likely use an outcome measurement tool to chart your progress and to determine your functional mobility and self-care independence. The FIM may be one tool that is used to help your physical therapist and other professionals determine your improvement during your episode of care. This outcome measurement can also give you a motivating morale boost—as your FIM score improves, you know that your overall mobility and functional are also improving. Be sure to ask your PT about the Functional Independence Measure and how it may be used in your own personal rehab journey.