Original research| Volume 99, ISSUE 8, P1479-1482.e1, August 2018

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Same But Different: FIM Summary Scores May Mask Variability in Physical Functioning Profiles

Published:February 08, 2018DOI:



      To examine how similar summary scores of physical functioning using the FIM can represent different patient clinical profiles.


      Retrospective cohort study.


      Inpatient rehabilitation facilities.


      Medicare fee-for-service beneficiaries (N=765,441) discharged from inpatient rehabilitation.


      Not applicable.

      Main Outcome Measures

      We used patients’ scores on items of the FIM to quantify their level of independence on both self-care and mobility domains. We then identified patients as requiring “no physical assistance” at discharge from inpatient rehabilitation by using a rule and score–based approach.


      In those patients with FIM self-care and mobility summary scores suggesting no physical assistance needed, we found that physical assistance was in fact needed frequently in bathroom-related activities (eg, continence, toilet and tub transfers, hygiene, clothes management) and with stairs. It was not uncommon for actual performance to be lower than what may be suggested by a summary score of those domains.


      Further research is needed to create clinically meaningful descriptions of summary scores from combined performances on individual items of physical functioning.


      List of abbreviations:

      CMS (Centers for Medicare and Medicaid Services), IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014), IRF-PAI (Inpatient Rehabilitation Facility – Patient Assessment Instrument), PAC (post–acute care)
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