Clinical use and inter rater agreement in the application of the functional independence measure

Background: The Functional Independence Measure (FIM) is an instrument wide ly used to assess the results and progress of a medical rehabilitation prog ram. Aim: To assess the inter rater agreement in the application of FIM and show the clinical experience with its use in disabled patients enrolled in a rehabilitation program. Patients and methods: FIM was applied in 40 pati ents and the inter rater agreement was assessed. comparing rates with and w ithout training in its use. Agreement was evaluated using Kappa test. After wards, the FIM was used to assess changes in 100 patients hospitalized and being rehabilitated at the Rehabilitation ward of a general hospital. Resul ts: Inter rater agreement is high in physical areas of FIM and low in cogni tive areas. Training significantly improves agreement in communication and cognitive areas. During a mean period of hospitalization of 38 days, FIM sc ore changed from a mean 47.2 to 92 points, with an improvement of 1.18 poin ts per hospitalization day. The higher improvement was achieved in the phys ical area of the instrument. Conclusions: Training is required for a proper application of FIM. When used adequately, this instrument allows as assess ment of the degree of disability and the changes obtained with rehabilitati on programs (Rev Med Chile 2001; 129: 23-31).