Functional independence staging: conceptual foundation, face validity, and empirical derivation.
OBJECTIVE
To develop a staging system for functional independence across the activities of daily living (ADLs), sphincter-management, mobility, and executive-function domains (ASME) for the FIM instrument that is consistent with the International Classification of Functioning, Disability and Health.


METHODS
National data were used to define the stages. We searched for the most likely configurations of item scores that increased ability to perform component activities in each domain by approximately 1 level per item per stage.


METHODS
Inpatient rehabilitation facilities.


METHODS
Data from 218,290 people discharged from 560 US inpatient rehabilitation facilities in 1995.


METHODS
Not applicable.


METHODS
Activity profiles formed from FIM scores.


RESULTS
Seven stages were defined separately for each ASME domain. Stages approximate the average amount of effort expended by the patient when performing the component activities included in a domain, beginning with less than 25% of effort at the lowest total assistance (stage 1) and ending with 100% effort at the highest complete independence (stage 7). Consistent with developmental principles, independence is achieved at lower stages in the most fundamental activities of eating, transfers, and communication. Recovery of independence in the more difficult activities of bathing, stair climbing, and problem solving does not occur until the higher stages are reached. The degree of independence is described with a shorthand abbreviation of the domains followed by the stage the patient has reached in each domain. For example, ASME 5,1,6,7 indicates need for supervision in the ADLs (A-5), total assistance in sphincter management (S-1), modified independence in mobility (M-6), and complete independence in executive functions (E-7).


CONCLUSIONS
ASME stages serve as a common language and shorthand for expressing the functional consequences of illness and injury, while complementing information about impairment and diagnosis, thereby facilitating communication, assessment, and goal setting in terms that are meaningful to patients and their care givers.
Stineman
Margaret G
MG
Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, Clinical Epidemiology Unit, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA.
Ross
Richard N
RN
Fiedler
Roger
R
Granger
Carl V
CV
Maislin
Greg
G
D000203:Activities of Daily Living / Q000145:classification*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical