The Utility of the FIM+FAM for Assessing Traumatic Brain Injury Day Program Outcomes

Abstract

OBJECTIVE: To evaluate the effectiveness of the FIM+FAM as a primary outcome measure for traumatic brain injury (TBI) comprehensive day programs. DESIGN: Retrospective data analysis. SETTING: Single center, TBI comprehensive day program facility. PARTICIPANTS: A demographically and regionally diverse sample of 105 persons with moderate or severe TBI admitted to the Shepherd Pathways comprehensive TBI day rehabilitation program. MAIN OUTCOME MEASURES: Functional Independence Measure + Functional Assessment Measure (FIM+FAM). RESULTS: Twenty-eight percent or fewer of participants reached ceiling effects on 25 of the 30 FIM+FAM items at day program admission with only 2% of clients rated above ceiling score levels on the FIM+FAM total score. The criteria of Guyatt et al showed that 20 of the 30 FIM+FAM items showed clinically meaningful improvements in 60% or more of clients. On average, clients with TBI improved over 27 points on the FIM+FAM total score. Fifteen of 30 items showed ceiling effects of 33% or less at discharge where only 25% of clients exceeded the FIM+FAM total score ceiling threshold. Discharge FIM+FAM motor scale was a very good predictor of the need for additional single service physical therapy. However, reaching ceiling rating on the FIM+FAM cognitive scale demonstrated poor specificity (0.28) and negative predictive power (0.42) for the need for additional speech/cognitive therapy services. CONCLUSIONS: The FIM+FAM demonstrated utility as an outcome measure for TBI comprehensive day program treatment in the current milieu. Future research is required to replicate and extend the current findings.