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功能独立性评定量表


注意！该文章为贵州三易医疗器械有限公司原创整理编辑，不经过本公司书面同意，不得以任何方式，包括但不限于电子、纸质的方式进行复制、传播及转载。原始发布时间：2026年8月29日。


功能独立性评定量表的概况


功能独立性评定量表（Functional Independence Measure，FIM）由美国物理医学与康复学会及美国康复医学Congress赞助的国家工作组于1984-1987年间开发，1987年由Keith、Granger、Hamilton和Sherwin发表。FIM的开发旨在解决Barthel指数在敏感性和全面性方面受到的批评，并基于《国际残损、残疾和残障分类》为美国医疗系统提供统一的残疾测量系统。患者的残疾水平表明其照护负担，项目评分依据为执行日常生活活动所需协助的程度。


功能独立性评定量表的目的


FIM用于评估患者的功能独立性，通过评定患者执行日常生活活动时所需的协助程度，全面测量运动和认知两大领域的功能状态，为康复结局评估、照护需求预测和出院去向判断提供依据。


功能独立性评定量表的测试项目与分量表


FIM由18个项目组成，评估6个功能领域，分为运动（13项）和认知（5项）两个分量表，分别称为运动FIM和认知FIM，运动项目基于Barthel指数的项目开发：


运动领域包括：1.自我照护（6项）：进食、梳洗、洗澡、穿上衣、穿下衣、如厕；2.括约肌控制（2项）：膀胱管理、肠道管理；3.转移（3项）：床/椅/轮椅、马桶、浴缸/淋浴；4.行动（2项）：步行/轮椅、楼梯。


认知领域包括：5.交流（2项）：理解、表达；6.社会认知（3项）：社会互动、问题解决、记忆。


就项目难度而言，运动FIM中最容易的项目为进食、梳洗和肠道管理，最具挑战的项目为浴缸/淋浴转移及行动类项目（步行/轮椅、楼梯）；认知FIM中最容易的项目为表达，最难为问题解决。


功能独立性评定量表的施测规则


FIM的评分基于患者的实际表现而非能力，可通过观察、患者访谈、电话访谈或病历记录获取。开发者建议评分由多学科团队共识得出。通常以访谈方式施测，脑卒中患者可由代理人作答：脊髓损伤患者可将FIM作为自评问卷完成；脑卒中患者可由现场代理人可靠地完成评定；也可通过电话代理人可靠使用（总FIM的ICC=0.91，运动FIM为0.94，认知FIM为0.52），结果与现场施测高度接近。


功能独立性评定量表的评分方法


每个项目按7点Likert量表评分，分数表示执行每项活动所需的协助量：1分为完全需要协助，7分为完全独立。总分范围18-126分，18分为完全依赖或完全协助，126分为完全独立。可分别计算运动FIM和认知FIM分量表分。需要注意的是，单一总分可能产生误导，分数间的区间在难度水平上并不相等，只能提供顺序量尺信息；有研究者应用Rasch评级量表将FIM的顺序评分转换为等距评分，使其可用于线性回归模型。


功能独立性评定量表的测试时间


FIM的施测和评分需30-45分钟，另需约7分钟收集人口学信息。


进行功能独立性评定量表测试之前需要进行培训吗？


FIM必须由经过培训且获得认证的评估者施测。对施测者的培训和教育可能构成显著成本，采用访谈形式可使FIM更适合纵向评估。


功能独立性评定量表需要什么样的设备？


FIM所需设备仅为患者用于执行日常生活活动的任何物品，无需专门设备。


功能独立性评定量表适合哪些患者群体使用？


FIM可用于所有年龄的脑卒中患者，包括伴有失语症或忽视等特殊状况的患者。此外还已在创伤性脑损伤、脊髓损伤、多发性硬化、接受住院康复的老年人群中测试，儿童最小可至7岁。未见已报告的使用限制。


功能独立性评定量表的心理测量学特性


信度方面：内部一致性在4项研究中均报告为极佳，如Dodds等人（1993）在11102例综合康复住院患者中测得Cronbachα系数为0.93（入院）和0.95（出院）；Hobart等人（2001）测得总FIMα=0.95、运动FIMα=0.95、认知FIMα=0.89。重测信度在5项研究中均为极佳，如Chau等人（1994）测得总FIM的ICC=0.93；Ottenbacher等人（1996）汇总11项研究共1568例患者，中位相关系数为0.95；Pollak等人（1996）在49例80岁以上老年人中测得运动FIM的ICC=0.90、认知FIM为0.80。评定者间信度在10项研究中8项为极佳，如Hamilton等人（1994）在1018例患者中测得总FIM的ICC=0.96、运动为0.96、认知为0.91；Segal和Schall（1994）在38例脑卒中患者中测得ICC=0.96。评定者内信度方面，Hobart等人（2001）测得总FIM的ICC=0.98。


效度方面：内容效度基于文献综述和专家小组创建，并在11个中心试点（包括8个不同学科的114名临床人员和110名评估患者），表面与内容效度通过Delphi法确立。同时效度方面，Hsueh等人（2002）在118例脑卒中患者中测得运动FIM与Barthel指数入院Spearman相关为0.74（极佳）、出院为0.92（极佳）；Kwon等人（2004）测得Barthel指数与运动FIM相关r=0.95，运动FIM与改良Rankin量表r=-0.89。预测效度方面：多发性硬化患者总FIM每提高1分预测他人每日协助减少3.38分钟，脑卒中患者为2.19分钟；入院FIM低于36分的患者无一出院回家，高于96分者全部出院回家；入院FIM低于40分者急性期住院时长几乎是其他分数的两倍，FIM大于80分者出院回家；入院FIM低于50分的患者出院时生活自理依赖，大于70分者出院时不依赖且住院时长短于平均水平；26339例患者的记录显示入院FIM大于37分者出院时能独立进食、梳洗、穿上衣和管理二便，大于55分者还能洗澡、穿下衣和完成转移；入院FIM得分是出院FIM得分的最强预测因子，入院FIM可极佳预测出院FIM得分（0.90，p小于0.001）；较低的入院前FIM得分可负向预测脑卒中患者5年生存（OR=1.04，95%CI为1.1-2.0，P=0.01）。结构效度方面，Rasch分析在14799例患者的入院和出院FIM得分中发现了运动和认知两个不同的残疾维度；FIM得分可区分基于脑卒中严重程度、合并症以及有无忽视和失语症的不同患者组别。聚合效度方面，总FIM和运动FIM与OPCS残疾量表呈极佳相关（r=0.82和0.84），认知FIM与简易精神状态检查呈极佳相关（r=0.666）。


地板/天花板效应方面：总FIM在多发性硬化和脑卒中患者中均无天花板效应（0%），认知FIM存在天花板效应（多发性硬化患者为36%，另一研究中为16.1%）；入院运动FIM的地板效应（5.8%）远小于Barthel指数（18.2%）；FIM在入院和出院时均无地板/天花板效应，而Barthel指数出院时有大幅天花板效应（27%）。


反应性方面：在7项研究中，3项报告FIM对脑卒中患者具有极佳的变化检测能力，4项报告对脑卒中或多发性硬化患者的变化检测能力差。具体而言，Van der Putten等人（1999）发现脑卒中患者运动FIM和总FIM的效应量大（ES=0.91和0.82），认知FIM为中等（ES=0.61），与Barthel指数效应量相似；Wallace等人（2002）测得运动FIM的ES=0.28、SRM=0.62、AUC为0.675，与Barthel指数反应性相似；Hsueh等人（2002）发现Barthel指数与运动FIM均具有高反应性（SRM=1.2）；Dromerick等人（2003）发现FIM的SRM优于Barthel指数（2.18对1.72），FIM是最敏感的测量，在95例受试者中检测到91例的变化；Hobart和Thompson（2001）测得总FIM的SRM=0.48、运动FIM为0.54、认知FIM为0.17；Beninato等人（2006）在113例患者中确定了FIM的最小临床重要差异：总FIM为22分、运动FIM为17分、认知FIM为3分。


功能独立性评定量表的版本


FIM有以下替代版本：1.儿童版FIM（WeeFIM）：用于追踪6个月至7岁儿童的残疾情况，若7岁以上儿童的功能能力低于无残疾7岁儿童的预期水平亦可使用，共18项，测量自我照护、移动和认知3个领域；2.改良5级FIM：基于老年脑卒中幸存者样本的研究发现，5级FIM很可能在不损失敏感性的情况下提高信度。语言版本方面，FIM已有德语、意大利语、西班牙语、瑞典语、芬兰语、葡萄牙语、南非荷兰语、土耳其语、法语和波斯语版本。


功能独立性评定量表的参考文献


  • Alexander, M. P. (1994). Stroke rehabilitation outcomes: A potential use of predictive variables to establish levels of care. Stroke, 25(1), 128-134.
  • Black, T. M., Soltis, T., Bartlett, C. (1999). Using the Functional Independence Measure instrument to predict stroke rehabilitation outcomes. Rehabilitation Nursing, 24(3), 109-114, 121.
  • Beninato, M., Gill-Body, K.M., Salles, S., Stark, P.C., Black-Schaffer, R.M. & Stein, J. (2006). Determination of the Minimal Clinically Important Difference in the FIM instrument in patients with stroke. Archives of Physical Medicine and Rehabilitation, 87, 32-39.
  • Brosseau, L., Wolfson, C. (1994). The inter-rater reliability and construct validity of the Functional Independence Measure for multiple sclerosis subjects. Clin Rehabi, 8, 107-115.
  • Brock, K. A., Goldie, P. A., Greenwood, K. M. (2002). Evaluating the effectiveness of stroke rehabilitation: Choosing a discriminative measure. Arch Phys Med Rehabil, 83(1), 92-99.
  • Cavanagh, S. J., Hogan, K., Gordon,V., Fairfax, J. (2000). Stroke-specific FIM models in an urban population. Journal of Neurological Nursing, 32, 17-21.
  • Chau, N., Dalter, S., Andre, J. M., Patris, A. (1994). Inter-rater agreement of two functional independence scales: The Functional Independence Measure (FIM) and a subjective uniform continuous scale. Disabil Rehabil, 16(2), 63-71.
  • Cifu, D., Keyser-Marcus, L., Lopez, E., Wehman, P., Kreutzer, J., Englander, J., High, W. (1997). Acute predictors of successful return to work 1 year after traumatic brain injury: A multicenter analysis. Archives of Physical Medicine and Rehabilitation, 78(2), 125-131.
  • Cooke, D. M., McKenna, K., Fleming, J. & Darnell, R. (2006). Construct and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). Scandinavian Journal of Occupational Therapy, 13, 49-61.
  • Corrigan, J. D., Smith-Knapp, K., Granger, C. V. (1997). Validity of the functional independence measure for persons with traumatic brain injury. Arch Phys Med Rehabil, 78(8), 828-834.
  • Daving, Y., Andren, E., Nordholm, L., Grimby, G. (2001). Reliability of an interview approach to the Functional Independence Measure. Clin Rehabil, 15(3), 301-310.
  • Demers, L., Giroux, F. (1997). Validite de la Measure de l’independeance fonctionelle (MIF) pour les personnes agees suivies en readaptation. Canadian Journal on Aging/La revue canadienne du vieillissement, 16(4), 626-646.
  • Dodds, T. A., Martin, D. P., Stolov, W. C., Deyo, R. A. (1993). A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil, 74(5), 531-536.
  • Dromerick, A. W., Edwards, D. F., Diringer, M. N. (2003). Sensitivity to changes in disability after stroke: A comparison of four scales useful in clinical trials. Journal of Rehabilitation Research and Development, 40, 1-8.
  • Fourn, L., Brosseau, L., Dassa, C., Dutil, E. (1994). Validation factorielle de la Mesure de l’independence functionelle (MIF) aupres de personnes atteintes de la sclerose en plaques. Journal de Readaptation Medicale, 14, 7-16.
  • Gosman-Hedstrom, G., Blomstrand, C. (2004). Evaluation of a 5-level Functional Independence Measure in a longitudinal study of elderly stroke survivors. Disability & Rehabilitation, 26(7), 410-418.
  • Granger, C. V., Deutsch, A., Linn, R. T. (1998). Rasch analysis of the Functional Independence Measure (FIM) Mastery Test. Arch Phys Med Rehabil, 79(1), 52-57.
  • Granger, C. V., Hamilton, B. B., Keith, R. A., Zielezny, M., Sherwins, F. S. (1986). Advance in functional assessment for medical rehabilitation. Top Geriatr Rehabil, 1, 59-74.
  • Granger, C. V., Cotter, A. C., Hamilton, B. B., Fiedler, R. C., Hens, M. M. (1990). Functional assessment scales: A study of persons with multiple sclerosis. Arch Phys Med Rehabil, 71, 870-875.
  • Granger, C. V., Cotter, A. C., Hamilton, B. B., Fiedler, R. C. (1993). Functional assessment scales: A study of persons with stroke. Arch Phys Med Rehabil, 74(2), 133-138.
  • Granger, C. V., Hamilton, B. B., Fiedler, R. C. (1992). Discharge outcomes after stroke rehabilitation. Stroke, 23(7), 978-982.
  • Grey, N., Kennedy, P. (1993). The Functional Independence Measure: a comparative study of clinician and self rating. Paraplegia, 31, 457-461.
  • Grimby, B., Gudjonsson, G., Rodhe, M., Sunnerhagen, K. S., Sundh, V., Ostensson, M. L. (1996). The Functional Independence Measure in Sweden: Experience for outcome measurement in rehabilitation medicine. Scandinavian Journal of Rehabilitation Medicine, 28, 51-62.
  • Hall, K. M., Hamilton, B., Gordon, W. A., Zasler, N. D. (1993). Characteristics and comparisons of functional assessment indices: Disability Rating Scale, Functional Independence Measure and Functional Assessment Measure. J Head Trauma Rehabil, 8(2), 60-74.
  • Hall, K. M., Mann, N., High, W., Wright, J., Kreutzer, J., Wood, D. (1996). Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS and CIQ. J Head Trauma Rehabil, 11(5), 27-39.
  • Hammond, F. M., Grattan, K. D., Sasser, H., Corrigan, J. D., Bushnik, T., Zafonte, R. D. (2001). Long-term recovery course after traumatic brain injury: A comparison of the Functional Independence Measure and Disability Rating Scale. Journal of Head Trauma, 16(4), 318-329.
  • Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., Granger, C. V. (1995). Interrater reliability of the 7-level functional independence measurement (FIM). Scand J Rehabil Med, 27, 253-256.
  • Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., Granger, C. V. (1994). Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil, 26, 115-119.
  • Heinemann, A. W., Linacre, J. M., Wright, B. D., Hamilton, B. B., Granger, C. (1994). Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil, 75(2), 133-143.
  • Hobart, J. C., Lamping, D. L., Freeman, J. A., Langdon, D. W., McLellan, D. L., Greenwood, R. J., Thompson, A. J. (2001). Which disability scale for neurologic rehabilitation? Neurology, 57, 639-644.
  • Hobart, J. C., Thompson, A. J. (2001). The five item Barthel index. J Neurol Neurosurg Psychiatry, 71, 225-230.
  • Hsueh, I-P., Lin, J-H., Jeng, J-S., Hsieh, C-L. (2002). Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke. Journal of Neurology Neurosurgery and Psychiatry, 73, 188-190.
  • Inouye, M., Kishi, K., Ikeda, Y., Takada, M., Katoh, J., Iwahasi, M., Hayakawa, M., Ishihara, K., Sawamura, S., Kazumi, T. (2000). Prediction of functional outcome after stroke rehabilitation. American Journal of Physical Medicine and Rehabilitation, 79(6), 513-518.
  • Jaworski, D. M., Kult, T., Boynton, P. R. (1994). The Functional Independence Measure: A pilot study comparison of observed and reported ratings. Rehabil Nur Res, 3, 141-147.
  • Katz, N., Hartman-Meier, A., Ring, H. & Soroker, N. (2000). Relationships of cognitive performance and daily function of clients following right hemisphere stroke: Predictive and ecological validity of the LOTCA battery. Occupational Therapy Journal of Research, 20, 3-17.
  • Keith, R. A., Granger, C. V., Hamilton, B. B., Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil, 1, 6-18.
  • Kidd, D., Stewart, G., Baldry, J., Johnson, J., Rossiter, D., Petruckevitch, A., Thompson, A. J. (1995). The Functional Independence Measure: A comparative validity and reliability study. Disabil Rehabil, 17(1), 10-14.
  • Küçükdeveci, A. A., Yavuzer, G., Elhan, A. H., Sonel, B. (2001). Adaptation of the Functional Independence Measure for use in Turkey. Clinical Rehabilitation, 15(3), 311-319.
  • Kwon, S., Hartzema, A. G., Duncan, P. W., Min-Lai, S. (2004). Relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke, 35, 918-923.
  • Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., Hamilton, B. B. (1994). The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil, 75(2), 127-132.
  • McDowell, I., Newell, C. (1996). Measuring health: a guide to rating scales and questionnaires (pp. 63-67). (2nd Ed.), New York: Oxford University Press.
  • Mokler, P. J., Sandstrom, R., Griffin, M., Farris, L., Jones, C. (2000). Predicting discharge destination for patients with severe motor stroke: Important Functional Tasks. Neurorehabilitation and Neural Repair, 14(3), 181-185.
  • Msall, M. E., DiGaudio, K., Rogers, B. T., LaForest, S., Catanzaro, N. L., Campbell, J., Wilczenski, F., Duffy, L. C. (1994). The Functional Independence Measure for Children (WeeFIM). Conceptual basis and pilot use in children with developmental disabilities. Clin Pediatr (Phila), 33(7), 421-430.
  • Naghdi S, Ansari NN, Raji P, Shamili A, Amini M, Hasson S. Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke. Disabil Rehabil. 2016;38(3):289-98. doi: 10.3109/09638288.2015.1036173.
  • Oczkowski, W. J., Barreca, S. (1993). The functional independence measure: Its use to identify rehabilitation needs in stroke survivors. Arch Phys Med Rehabil, 74(12), 1291-1294.
  • Ottenbacher, K. J., Hsu, Y., Granger, C. V., Fiedler, R. C. (1996). The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil, 77(12), 1226-1232.
  • Ottenbacher, K. J., Mann, W. C., Granger, C. V., Tomita, M., Hurren, D., Charvat, B. (1994). Inter-rater agreement and stability of functional assessment in the community-based elderly. Arch Phys Med Rehabil, 75(12), 1297-1301.
  • Pollak, N., Rheault, W., Stoecker, J. L. (1996). Reliability and validity of the FIM for persons aged 80 years and above from a multilevel continuing care retirement community. Arch Phys Med Rehabil, 77(10), 1056-1061.
  • Ring, H., Feder, M., Schwartz, J., Samuels, G. (1997). Functional measures of first-stroke rehabilitation inpatients: Usefulness of the Functional Independence Measure total score with a clinical rationale. Arch Phys Med Rehabil, 78(6), 630-635.
  • Segal, M. E., Schall, R. R. (1994). Determining functional/health status and its relation to disability in stroke survivors. Stroke, 25, 2391-2397.
  • Segal, M. E., Ditunno, J. F., Staas, W. E. (1993). Interinstitutional agreement of individual functional independence measure (FIM) items measured at two sites on one sample of SCI patients. Paraplegia, 31(10), 622-631.
  • Segal, M. E., Gillard, M., Schall R. (1996). Telephone and in-person proxy agreement between stroke patients and caregivers for the functional independence measures. Am J Phys Med Rehabil, 75(3), 208-212.
  • Sharrack, B., Hughes, R. A., Soudain, S., Dunn, G. (1999). The psychometric properties of clinical rating scales used in multiple sclerosis. Brain, 122(1), 141-159.
  • Singh, A., Black, S. E., Herrmann, N., Leibovitch, F. S., Ebert, P. L., Lawrence, J., Szalai, J. P. (2000). Functional and neuranatomic correlations in poststroke depression. Stroke, 31, 637-644.
  • Stineman, M. G., Fiedler, R. C., Granger, C. V., Maislin, G. (1998). Functional task benchmarks for stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 79, 497-504.
  • Teasell, R., Foley, N. C., & Salter K. (2011). EBRSR: Evidence-Based Review of Stroke Rehabilitation. 13th ed. London (ON): EBRSR.
  • Timbeck, R. J., Spaulding, S. J. (2003). Ability of the Functional Independence Measure to predict rehabilitation outcomes after stroke: A review of the literature. Physical & Occupational Therapy in Geriatrics, 22(1), 63-76.
  • Tur, B.S., Gursel, Y.K., Yavuzer, G., Kucukdeveci, A. & Arasil, T. (2003). Rehabilitation outcome of Turkish stroke patients: In a team approach setting. International Journal of Rehabilitation Research, 26, 271-277.
  • van der Putten, J. J., Hobart, J. C., Freeman, J. A., Thompson, A. J. (1999). Measuring change in disability after inpatient rehabilitation: Comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. Neurol Neurosurg Psychiatry, 66, 480-484.
  • Wallace, D., Duncan, P. W., Lai, S. M. (2002). Comparison of the responsiveness of the Barthel Index and the motor component of the Functional Independence Measure in stroke: the impact of using different methods for measuring responsiveness. J Clin Epidemiol, 55, 922-928.
  • Ween, J. E., Mernoff, S. T., Alexander, M. P. (2000). Recovery rates after stroke and their impact on outcome prediction. Neurorehabilitation and Neural Repair, 14(3), 229-235.
  • Whiting, R., Shen, Q., Hung, W.T., Cordato, D. & Chan, D.K.Y (2010). Predictors for 5-year survival in a prospective cohort of elderly stroke patients. Acta Neurologica Scandinavica, DOI: 10.1111/j.1600-0404.2010.01476.
  • Zwecker, M., Levenkrohn, S., Fleisig, Y., Zeilig, G., Ohry, A., & Adunsky, A. (2002). Mini-Mental State Examination, cognitive FIM instrument, and the Loewenstein Occupational Therapy Cognitive Assessment: relation to functional outcome of stroke patients. Archives of Physical Medicine and Rehabilitation, 83, 342-345.

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