The UK FIM+FAM Extended Activities of Daily Living module: evaluation of scoring accuracy and reliability.
OBJECTIVE
The UK Functional Assessment Measure (UK FIM+FAM) is a widely used outcome measure in brain injury rehabilitation. An Extended Activities of Daily Living (EADL) module was included in its original development, but has never been formally evaluated. This study evaluated its scoring accuracy and reliability using vignettes (short clinical scenarios).


METHODS
A set of vignettes was developed and tested by a panel of experienced UK FIM+FAM trainers to derive 'gold standard' scores. To evaluate scoring accuracy, these were subsequently compared with scores made by 12 rehabilitation professionals; first individually, and then together in four multi-disciplinary (MD) teams to reflect clinical practice. Scoring was repeated after 1 month. Inter-rater and intra-rater reliability were evaluated for both individual and MD team scores using weighted Cohen's kappa statistics.


RESULTS
Agreement with 'gold standard scores' was excellent, ranging from k(w) = 0.88-0.97 (individuals) and k(w) = 0.93-1.00 (MD teams). Inter-rater agreement was good to excellent, ranging from k = 0.68-0.92 (individuals) and k = 0.74-1.00 (MD teams). Test-retest agreement was excellent, ranging from k(w) = 0.92-1.00 (individuals) and k(w) = 0.89-0.99 (MD teams).


CONCLUSIONS
This vignette-based study demonstrated high levels of scoring accuracy and reliability for the EADL items of the UK FIM+FAM. Further testing in real-life situations is now warranted.
Law
Janet
J
Northwick Park Hospital, King's College London School of Medicine, London, UK.
Fielding
Beverley
B
Jackson
Diana
D
Turner-Stokes
Lynne
L
D000203:Activities of Daily Living; D001930:Brain Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D004185:Disability Evaluation; D006801:Humans; D017063:Outcome Assessment, Health Care; D011594:Psychometrics; D020127:Recovery of Function; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D006113:United Kingdom