FIMFAM OUTCOME MEASURES Presented by Caroline Ray On

FIM+FAM – OUTCOME MEASURES Presented by Caroline Ray On behalf of Queen Elizabeth’s Foundation Brain Injury Centre, Banstead, Surrey.

FIM+FAM: A BACKGROUND l Functional assessment measures have been in use for half a century in rehabilitation to plan and evaluate care, determine compensation and predict prognosis. l The Barthel Scale (1965), commonly used by nursing staff measures activities such as: feeding, grooming, bathing, dressing, transfers and mobility but it does not address cognitive/social issues.

FIM+FAM: A BACKGROUND l In the early 1980 s an American task force took items from existing ‘physical’ scales and developed the Functional Independence Measure (FIM). l This was intended to create a global measure of disability but one which additionally addressed cognitive/psycho-social issues and which could be considered to be reliable regardless of clinical background of user.

FIM+FAM: A BACKGROUND l The FIM is an 18 item measurement that evaluates a person’s functional status and abilities. Monitoring of scores therefore reflects progress and the clients discharge destination. l Functional Assessment Measure extends the coverage of the FIM and this scale was developed in the USA and adapted for the UK in 1993 (last modified in 1999).

FIM+FAM UK: OUTCOME MEASURE l It adds an additional 12 items to the FIM which are around cognition and tests attention levels, problem solving, comprehension, expression, memory and social interaction, reading and writing skills and employability. l Status on admission, according to FIM+FAM scales, provides the clinical baselines and focus for treatment. It is recommended that the FIM+FAM is scored by a multi-disciplinary team, which improves inter-rated reliability.

FIM+FAM: QEF BIC MODEL l Levels of dependency in activities of daily living, cognitive and communication, literacy and emotional adjustment are regularly assessed during the students rehabilitation and at discharge. l Assessment Scale runs from 1 - being the requirement of total assistance (the individual performs less that 25% of the task) to 7 complete independence (the task is completed in a timely and safely manner).

FIM+FAM: QEF BIC MODEL l Data collected clearly shows the progress that clients make during their rehabilitation from which valuable evidence can be extrapolated, for example: l 91% of clients have made progress in completing personal care, 100% have made progress with physical skills while a further 75% of clients have made progress with literacy and cognition.

WHY MEASURE OUTCOMES? l l l To convince purchasers of services and demonstrate that rehabilitation is effective To help direct therapies; identify which areas to work on Encourage team communication and joint working Data can be used to compare different services and client populations Clearly demonstrate progress with physical and cognitive abilities and the subsequent reduced ‘burden of care’

Further information l QEF, BIC Contact Head of Clinical Services – lynne. hensor@qef. org. uk l FIM/FAM training at Northwick Park Hospital, Harrow, Middx. Oct. 2011 cost £ 100 person. FACS (AHSA) l Assessment to measure functional communication of adults with speech, language and cognitive communication disorders (including social communication, communication of daily needs, reading, writing, number concepts and daily planning. )