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[Instrument for the functional evaluation of disability rehabilitation. Study on the reliability and clinical experience with the use of functional independence measure].

BACKGROUND
The Functional Independence Measure (FIM) is an instrument widely used to assess the results and progress of a medical rehabilitation program.


AIM
To assess the inter rater agreement in the application of FIM and show the clinical experience with its use in disabled patients enrolled in a rehabilitation program.


PATIENTS AND METHODS
FIM was applied in 40 patients and the inter rater agreement was assessed, comparing raters with and without training in its use. Agreement was evaluated using Kappa test. Afterwards, the FIM was used to assess changes in 100 patients hospitalized and being rehabilitated at the Rehabilitation ward of a general hospital.


RESULTS
Inter rater agreement is high in physical areas of the FIM and low in cognitive areas. Training significantly improves agreement in communication and cognitive areas. During a mean period of hospitalization of 38 days, FIM score changed from a mean of 47.2 to 92 points, with an improvement of 1.18 points per hospitalization day. The higher improvement was achieved in the physical area of the instrument.


CONCLUSIONS
Training is required for a proper application of FIM. When used adequately, this instrument allows an assessment of the degree of disability and the changes obtained with rehabilitation programs.