Using The FIM Scale To Assess And Treat For Next Level Of Care.

Activities of Daily Living (ADLs) are a series of measurements that determine the functional status of a patient. As a skilled therapist, you should be able to develop or master a way of understanding if a patient may or may not be improving from an injury or Neurological event. Depending on your discipline and/or setting, these ADLs may differ drastically. Your goal is to optimize your patient’s output relative to their prior level of function. Your patient’s level of function can’t be gleaned or quantified without a system of measurement or data points, so system’s of measurement have been created and are being widely used by therapists in all settings.Activites of Daily Living

Many rehabilitation facilities use a version of the Functional Independence Measure (FIM). FIM as a standardized way of keeping track, or “score,” of how a patient is or is not improving. The FIM measures progress in activities of daily living, mobility, and communication. Barring unusual circumstances, a rehab patient is expected to gain one or two points per day.  Tasks are rated on a 7 point ordinal scale that ranges from total assistance (or complete dependence) to complete independence. The FIM is measured by five primary categories, including 18 individual task areas, and takes under an hour to administer.  Here are the five categories and their respective task area:

  1. Self-Care: Eating, Bathing, Upper Body Dressing, Lower Body Dressing, Toileting
  2. Sphincter Control:  Bladder Management, Bowel Management
  3. Transfers:  Bed, Chair and Wheelchair, Toilet, Tub and Shower
  4. Locomotion: Walking or using a Wheelchair, Stairs
  5. Cognitive: Communication (Comprehension & Expression), Social Cognition (Social Interaction and Problem Solving), Memory

Whether you are a Physical Therapist, Occupational Therapist or Speech-Language Pathologist,  Activities of Daily Living vary as they relate to the patient’s dysfunction. By utilizing scales such as the FIM, you are able to ascertain what the patients prior level of function was, in order to facilitate and progress the patient’s function to the next level of care.Many therapists find themselves treating patients with varying levels of ADLs relative to their injury, which is directly related to the setting they are being assessed in.

Acute Care Hospitals may be the most challenging environment to assess, plan, treat, and discharge because the patient’s average length of stay is 4.5 days. Whereas, in an Acute Care Rehab or Skilled Nursing Facility, you have more time with the patient to more deeply assess their potential and help them progress as needed.

Conversely, in the home environment, the patient gets to show you what they can do, and how their functional level helps them integrate into the home setting.Regardless of your discipline (PT, OT, or SLP) or setting (Acute Care, Acute Rehab, SNF, Outpatient, or Homecare), your end goal is helping patients matriculate to the next level of care while improving function.

Using the FIM score, or any other tools that help you quantify your patient’s function, will make you a better professional and also reduce the time a patient is treated, allowing them to get back to their standard activities of daily living.

Here at Centra Healthcare Solutions, we have many rehab therapy positions just waiting for a skilled professional to fill them. Whether you’re looking for the excitement of a travel therapy job, the flexibility of temporary positions or if you desire a regular, full-time position, contact us today.

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