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A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models

Published:April 28, 2018DOI:https://doi.org/10.1016/j.apmr.2018.04.005

      Highlights

      • Factor structure of FIM+FAM explored in acquired brain injury patients
      • 3-factor bifactor structure presents best fit of FIM+FAM data
      • Evidence of convergence towards a single factor to describe overall functioning

      Abstract

      Objective

      To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients.

      Design

      Criterion standard.

      Setting

      A National Health Service acute acquired brain injury inpatient rehabilitation hospital.

      Participants

      Referred sample of adults (N=447) admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitation

      Intervention

      Not applicable.

      Outcome Measure

      Functional Independence Measure and Functional Assessment Measure.

      Results

      Exploratory factor analysis suggested a 2-factor structure to FIM+FAM scores, among both focal-proximate and diffuse-proximate acquired brain injury aetiologies. Confirmatory factor analysis suggested a 3-factor bifactor structure presented the best fit of the FIM+FAM score data across both aetiologies. However, across both analyses, a convergence was found towards a general factor, demonstrated by high correlations between factors in the exploratory factor analysis, and by a general factor explaining the majority of the variance in scores on confirmatory factor analysis.

      Conclusions

      Our findings suggested that although factors describing specific functional domains can be derived from FIM+FAM item scores, there is a convergence towards a single factor describing overall functioning. This single factor informs the specific group factors (eg, motor, psychosocial, and communication function) after brain injury. Further research into the comparative value of the general and group factors as evaluative/prognostic measures is indicated.

      Keywords

      List of abbreviations:

      ABI (acquired brain injury), CFI (comparative fit index), CFA (confirmatory factor analysis), CMINI/DF (relative chi-square degrees of freedom), EFA (exploratory factor analysis), FIM+FAM (Functional Independence Measure and Functional Assessment Measure), KMO (Keiser-Meyer-Olkin), NNFI (non-normed fit index), RMSEA (root mean square of approximation), SRMSR (standardised root mean square residual)
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