Functional Independence Measure (FIM)

The Functional Independence Measure (FIM) is an outcome measurement tool that doctors, nurses, therapists, or interdisciplinary assessment teams used to assess patients' ability to complete specific functional tasks while recovering from a stroke, traumatic spinal cord injury, traumatic brain injury, or cancer, among others. While the FIM was primarily employed in acute hospitals and subacute rehabilitation centers, it was also used in any healthcare facility in which patients undergo rehabilitation for functional mobility impairments or for assessment of progress during inpatient rehabilitation. Specifically, the FIM measured and tracked the degree of assistance a person requires to complete everyday tasks. The FIM included a total of eighteen items that correspond to daily activities and that could be used to evaluate functions such as self-care, mobility, and communication. In 2019, the Centers for Medicare & Medicaid Services (CMS) removed FIM from the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) for inpatient rehabilitation facility reporting and required that Section GG codes be used instead to assess mobility and self-care.

Overview

The FIM was made up of a series of eighteen items designed to evaluate a patient's ability to carry out everyday functions. Using the FIM gave healthcare providers useful insight into how much assistance patients might need to perform everyday activities. These activities included everything from walking to self-care, communication, and general mobility.

Specifically, the FIM was divided into six separate categories tied to different functional mobility tasks. These categories included self-care, sphincter control, mobility, locomotion, communication, and social cognition. Each of these categories was further divided into several subcategories. Self-care included subcategories like feeding, grooming, bathing, upper and lower body dressing, and toileting. Sphincter control included both bladder and bowel management. The mobility category covered patients' ability to use a shower or tub, as well as their ability to move from bed to wheelchair and toilet to wheelchair. The locomotion category included subcategories tied to patients' ability to climb stairs and walk and/or use a wheelchair. Subcategories of the communication category included both comprehension and expression. The social cognition category included subcategories like social interaction, problem-solving, and memory.

Each of the items on the FIM was scored on a scale of one to seven. A score of seven meant that the patient was entirely independent in the activity being graded. A score of one meant that the patient was entirely dependent on assistance in the activity being graded. As a result, the lowest possible FIM score was 18 and the highest was 126. In most cases, a patient's initial FIM score was determined within the first seventy-two hours after they had been admitted to a rehabilitation facility.

The FIM was useful in a number of ways. First and foremost, the insight the FIM provided on a patient's level of functional mobility could be used to set reasonable and realistic rehabilitation goals. The FIM could also be used to gauge a patient's progress over the course of their rehabilitation. In addition, a patient's FIM score was a helpful piece of data for physical therapists to have on hand and consult while working with the patient's other rehabilitation providers during treatment. Finally, physical therapists often used the FIM score to assess a patient's overall safety in relation to mobility. The more assistance a patient needed, the lower their FIM score would be. With that in mind, physical therapists could use the FIM score to determine how capable the patient was of moving around and completing functional tasks safely.

However, in 2019, FIM was replaced with Section GG self-care and mobility items as the standard assessment tool for mandatory reporting in inpatient rehabilitation facilities in the United States as per the mandate of the CMS.

Bibliography

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“Functional Independence Measure (FIM) – Study Topic Overview.” Pass the OT, passtheot.com/study-topics/functional-independence-measure-fim-study-topic-overview. Accessed 6 Mar. 2026.

Sears, Brett. "How Functional Independence Measurement (FIM) is Used in Rehab." Verywell Health, 11 Sept. 2024, www.verywellhealth.com/the-functional-independence-measurement-2696063. Accessed 6 Mar. 2026.

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Somerville, Emily et al. “Differences in Daily Activity Performance between Inpatient Rehabilitation Facility and Home Among Stroke Survivors.” Neurorehabilitation and neural repair vol. 38, no. 6, 2024, pp. 403-412. doi:10.1177/15459683241246266. Accessed 6 Mar. 2026.