Reliability and validity of the Spanish adaptation of the Functional Independence Measure + Functional Assessment Measure.
Carolina Colomer, Roberto Llorens, Clara Sánchez and 5 others
PMID 37226445WHAT IT FOUND
The Spanish FIM+FAM measured functional independence after stroke consistently.
Two raters agreed almost perfectly, and scores tracked other disability and mobility measures. It is best used for overall independence, not as a detailed cognitive or communication test.
Key findings
01The Spanish FIM+FAM had high internal consistency, with Cronbach’s alpha values of .973 for the 30 original items and .974 including the 6 Extended Activities of Daily Living items.
02Inter-rater reliability was excellent, with intraclass correlations above 0.990 in all domains, including the cognitive domains.
03The scale showed convergent validity with other stroke measures, with motor subscales strongest against the Barthel Index, Disability Rating Scale, and Clinical Outcome Variables Scale, and the Communication module strongest against the Mississippi Aphasia Screening Test.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study was done in one Spanish neurological rehabilitation institute, so the results may not apply to other countries, languages, or stroke settings. Only 31 participants were randomly selected for a second rating, so the inter-rater evidence comes from a subset of the main sample. The authors note that very high internal consistency can also mean some items are redundant. The FIM+FAM had stronger relationships with motor and disability measures than with cognitive tests, so the total score may not fully capture cognitive or communication problems.
Declared interests
The authors declared no conflict of interest with any financial organization. The study was partially funded by Ministerio de Ciencia y Educación of Spain (RTC2019-006933-7) and Conselleria d’Innovació, Universitats, Ciència i Societat Digital of the Generalitat Valenciana (CIDEXG/2022/15).
The easy way to misread this
Do not conclude that the Spanish FIM+FAM is a sensitive measure of cognition or communication just because it has cognitive and communication subscales. The paper found its strongest relationships were with motor and disability measures, and its correlations with cognitive tests were weaker.