Functional Assessment Measure

Traumatic Brain Injury: (Grauwmijer et al, 2012; n=113; mean age = 33.2 (13.1) years; moderate TBI =26% and severe TBI = 74%)

• A FAM cut off score of < 65 to identify patients at risk of long-term unemployment had a good diagnostic value (odds ratio 6.9; 95% confidence interval, 2.5-19.4). Had a sensitivity of 75%, specificity of 70%, positive predictive value of 65% and negative predictive value of 79%.

Traumatic Brain Injury: (Hall et al, 1996; n=80 cases with FIM+FAM data, acute rehab to 2 years post injury)

Traumatic Brain Injury: (Powel et al., 2005; n=56; mean age = 42 years; standard deviation = 14 years)

• Excellent test-retest reliability: ranged 0.84-0.97

Traumatic Brain Injury: (Mcpherson et al., 1996; n=54; 76% male; traumatic brain injury patients)

• Excellent interrater reliability: good (kappa values = 0.50 to 0.95) for all but one of the 30 items rated on the FIM+FAM
• The exception (with a kappa = 0.35) was "adjustment to limits"
• Higher agreement was found for rating of physical activities than for cognitive, communication and behavioral items

Traumatic Brain Injury: (Law et al, 2009; Twelve allied health professionals from two neurorehabilitation units: four occupational therapists, four physiotherapists and four nurses)

• Inter-rater agreement across all items at test time 1 was 83% (k=0.80) for individuals and 91% (k=0.90)

Traumatic Brain Injury: (Donaghy et al., 1998; mean age = 38 yo; Severe TBI n=53 (40 men, 13 women))

• ICC >.60 for 29 of 30 items
• Poor: Social Interaction (ICC=0.36)
• Adequate: The next poorest correlation was FAM item Emotional Status (ICC=0.62)
• Adequate: The addition of FAM items to the cognitive/psychosocial domain increased reliability of this subscale to 0.74 from 0.69 for the FIM items alone.
• Excellent: For the 18 FIM items (ICC=0.85) vs. for 30 FIM+FAM items ( ICC=0.83)

Traumatic Brain Injury: (Law et al., 2008; Twelve Allied Health Professionals from two neurorehabilitation units (four occupational therapists, four physiotherapists and four nurses)

• Excellent intra-rater agreement: across all items between test times 1 and 2 was 87% (Weighted Kappa= 0.93) for individuals and 94% (Weighted Kappa = 0.97)

TBI: (Hawley et al; n=652, traumatic brain injury patients from 3 sites in Scotland)

• Excellent internal consistency: Cronbach’s alpha = 0.99 complete measure. Physical=0.98; Cognitive= .99 

Traumatic Brain Injury: (Hall et al., 1993; n=332 patients with TBI; TBI Model systems)

• FAM items rated at rehabilitation admission correlated significantly with indices of injury severity in a very similar pattern as FIM items. 

Traumatic Brain Injury: (Seel et al., 2007; n=105; moderate or severe TBI; mean age = 31.8 years (median = 26; SD = 13.9; range = 16–69))

• Predictive validity of FIM+FAM motor scores for physical therapy referrals:

∗Sensitivity indicates 0.88; specificity, 0.65; positive predictive value, 0.68; and negative predictive value, 0.86

Traumatic Brain Injury: (Hawley et al. 1999; n=652, traumatic brain injury patients from 3 sites in Scotland)

• Construct validity: FIM+FAM not unidimensional -- factor analysis demonstrated 2 principal components with eigen values > 1 – 16 items reflect physical functioning and 14 items reflect cognition, language and psychosocial functioning

Traumatic Brain Injury: (Gurka et al. 1999; ABIEBR website) 

• Linear regression analysis revealed FIM+FAM cognition scores at 6 months explained 33% of variance in CIQ scores at 6 months post-discharge while FIM+FAM motor scores accounted for 22% of variance
• This was compared to FIM cognition & motor scores that accounted for 31% & 21% of the variance, respectively

Traumatic Brain Injury: (Gurka et al. 1999; n=167)

• 80 – 90% of patients obtained “near maximum” scores on the FAM

Traumatic Brain Injury: (Hall et al. 1993; ABIEBR website) 

• Rasch analysis revealed FAM items cover a wider range of difficulty than the FIM items and, therefore, expand the range of scale difficulty beyond the FIM alone
• Both FIM and FAM items tend to cluster in the mid-range 

Traumatic Brain Injury: (TBI Model System National Database, Hall et al., 1996; Combi site; ABIEBR)

• When ceiling effect is defined at scoring 180 on the FIM + FAM, 34% of patients scored in the ceiling range at discharge from rehabilitation and 79% at one year post discharge
• This represented an improvement over the FIM (49%, 84%) – there was no advantage in terms of ceiling effect seen with regard to cog-FIM and the cognitive items of the FIM+FAM
• There is evidence that the FAM at rehabilitation discharge has less "ceiling effect" than the FIM and is more strongly related to rehabilitation charges than the FIM

Interrater Agreement: (Hall et al., 1992)

• Preliminary data suggest that FAM items involving abstract concepts such as "attention" tend to be less reliable than directly observable behaviors
• The percentage of rating agreement was 89%
• Excellent: Kappa score for the FIM =0.87, and for the FAM Kappa = 0.85
• Individual raters (OT, PT, COTA, researcher, data analyzer) ranged in agreement with the "correct answer," from a high of 94% to a low of 81% of composite percentages across items

Neurological disorders: (Hobart et al, 2001; n=149; stroke, MS, head injury and other)

• Excellent: FIM +FAM total= 0.98
• Excellent: FIM+FAM motor= 0.98
• Excellent: FIM + FAM cognitive=0.97

Neurological Rehabilitation patients: (Hobart et al, 2001; n=149; stroke, MS, head injury and other)

• FAM is suitable for several central nervous system conditions, as it verifies the level of global disability as a result of cognitive deficits
• Excellent internal consistency: Cronbach's alpha = 0.96 Total FIM + FAM; 0.96 Motor-FIM + FAM; 0.91 Cognitive FIM + FAM.

“The FAM items were developed by clinicians representing each of the disciplines in an inpatient rehabilitation program. The FAM was developed as an adjunct to the FIM to specifically address the major functional areas that are relatively less emphasized in the FIM, including cognitive, behavioral, communication and community functioning measures” (COMBI website).

Rehabilitation patients: (Hobart et al., 2001; n=149 patients; stroke, MS, head injury and other)

• Small to moderate: SRM means for FIM+FAM total, motor FIM+FAM and cognitive FIM+FAM were reported to be 0.42, 0.52 and 0.19 respectively – there were no significant floor or ceiling effects reported for FIM+FAM.