NSW Brain Injury Rehabilitation Forum May 2011

 

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There is more to the cognitive FIM items than meets the eye : analysis of psychometric properties and administration realities
ANNA PFAFF, Brain Injury Rehabilitation Unit, Liverpool Hospital

 

Title: There is more to the cognitive items on the FIM than meets the eye: analysis of the psychometric properties and administration realities

Authors: Donna Wakim\ Robyn Tate':", Anna Pfaff3, Natasha l.annin':", Christine Taylor", Pamela David', Bronwyn Coward'S Carmel Whitty1.
1. Rehabilitations Study Unit, Northern Clinical School, University of Sydney
2. Brain Injury Unit, Royal Rehabilitation Centre, Sydney
3. Brain Injury Rehabilitation Unit, Liverpool Hospital.

The 18-item Functional Independence Measure (FIM) is the most widely used assessment undertaken in rehabilitation. Although there is substantial psychometric evidence to support the validity of the Motor Scale of the FIM, surprisingly little empirical data are available for the Cognitive Scale. While rating of the motor items is relatively straightforward, rating the cognitive items can prove difficult especially at time of admission to rehabilitation and in practice methods used to do the ratings varies.

This research study examined the criterion and construct validity of the FIM Cognitive Scale. Conducting the study also highlighted some practical considerations and some dilemmas of administering the FIM. Sixty-seven people with TBI from inpatient rehabilitation (n=35) and community outreach (n=32) programs in Sydney were administered the FIM and other measuring instruments. Validating instruments were selected to specifically target each of the five FIM cognitive items, and included both objective cognitive tests and relative report using standardized questionnaires. A cohort study design was used.

Correlation coefficients between similar constructs of objective tests and relevant FIM cognitive item were, at best, modest. For example, in the inpatient sample at 6 months post-trauma, correlation between the FIM- Memory item and the Rivermead Behavioural Memory Test was low (r=O.29). Somewhat higher coefficients were found for the questionnaire data, for example, FIM-Memory and the Prospective and Retrospective Memory Questionnaire was r=-O.61.

The results of the research raise questions about the criterion and construct validity of the Cognitive Scale of the FIM for people with TBI.