The utility of the FIM+FAM for assessing traumatic brain injury day program outcomes.
OBJECTIVE
To evaluate the effectiveness of the FIM+FAM as a primary outcome measure for traumatic brain injury (TBI) comprehensive day programs.


METHODS
Retrospective data analysis.


METHODS
Single center, TBI comprehensive day program facility.


METHODS
A demographically and regionally diverse sample of 105 persons with moderate or severe TBI admitted to the Shepherd Pathways comprehensive TBI day rehabilitation program.


METHODS
Functional Independence Measure + Functional Assessment Measure (FIM+FAM).


RESULTS
Twenty-eight percent or fewer of participants reached ceiling effects on 25 of the 30 FIM+FAM items at day program admission with only 2% of clients rated above ceiling score levels on the FIM+FAM total score. The criteria of Guyatt et al showed that 20 of the 30 FIM+FAM items showed clinically meaningful improvements in 60% or more of clients. On average, clients with TBI improved over 27 points on the FIM+FAM total score. Fifteen of 30 items showed ceiling effects of 33% or less at discharge where only 25% of clients exceeded the FIM+FAM total score ceiling threshold. Discharge FIM+FAM motor scale was a very good predictor of the need for additional single service physical therapy. However, reaching ceiling rating on the FIM+FAM cognitive scale demonstrated poor specificity (0.28) and negative predictive power (0.42) for the need for additional speech/cognitive therapy services.


CONCLUSIONS
The FIM+FAM demonstrated utility as an outcome measure for TBI comprehensive day program treatment in the current milieu. Future research is required to replicate and extend the current findings.
Seel
Ronald T
RT
Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA. ron_seel@shepherd.org
Wright
Greg
G
Wallace
Tracey
T
Newman
Sary
S
Dennis
Leanne
L
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001930:Brain Injuries / Q000534:rehabilitation*; D003071:Cognition; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011594:Psychometrics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013070:Speech Therapy