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)To read this article in full you will need to make a payment
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References
- Return to work following traumatic brain injury: Trends and challenges.Disabil Rehabil. 2007; 29 (Available at): 1387-1395http://www.ncbi.nlm.nih.gov/pubmed/17729084Date accessed: December 3, 2017
- The UK functional assessment measure (UK FIM+FAM): psychometric evaluation in patients undergoing specialist rehabilitation following a stroke from the national UK clinical dataset.PLoS One. 2016; 11 (Available at)e0147288http://www.ncbi.nlm.nih.gov/pubmed/26824696Date accessed: December 3, 2017
- BSRM standards for rehabilitation services mapped on to the National Service framework for long-term conditions BSRM standards for rehabilitation services, mapped on to the National Service framework for long-term conditions.(Available at)https://www.bsrm.org.uk/downloads/standardsmapping-final.pdfDate: 2009Date accessed: December 16, 2017
- The UK FIM+FAM: development and evaluation.Clin Rehabil. 1999; 13 (Available at): 277-287http://www.ncbi.nlm.nih.gov/pubmed/10460115Date accessed: December 16, 2017
- The UK FIM+FAM extended activities of daily living module: evaluation of scoring accuracy and reliability.Disabil Rehabil. 2009; 31 (Available at): 825-830http://www.ncbi.nlm.nih.gov/pubmed/19037776Date accessed: December 16, 2017
- A comprehensive psychometric evaluation of the UK FIM + FAM.Disabil Rehabil. 2013; 35 (Available at): 1885-1895http://www.ncbi.nlm.nih.gov/pubmed/23384240Date accessed: December 16, 2017
- Use of the functional assessment measure (FIM+FAM) in head injury rehabilitation: a psychometric analysis.J Neurol Neurosurg Psychiatry. 1999; 67 (Available at): 749-754http://www.ncbi.nlm.nih.gov/pubmed/10567491Date accessed: October 20, 2017
UK FIM+FAM Users Group. The UK FIM+FAM (functional assessment measure) version 2.2. Middlesex: 2010. Available at https://www.kcl.ac.uk/nursing/departments/cicelysaunders/resources/FIMFAM-manual-v2.2-Sept-2012-print-double-sided.pdf. Accessed December 26, 2017.
- Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals.Arch Phys Med Rehabil. 2001; 82 (Available at): 367-374http://www.sciencedirect.com/science/article/pii/S0003999301477380Date accessed: October 20, 2017
- The UK functional assessment measure (UK FIM+FAM): psychometric evaluation in patients undergoing specialist rehabilitation following a stroke from the national UK clinical dataset.PLoS One. 2016; 11 (Available at)e0147288http://dx.plos.org/10.1371/journal.pone.0147288Date accessed: October 18, 2017
- Bifactor models and rotations: exploring the extent to which multidimensional data yield univocal scale scores.J Pers Assess. 2010; 92 (Available at): 544-559http://www.ncbi.nlm.nih.gov/pubmed/20954056Date accessed: September 30, 2017
- Factors predictive of stroke outcome in a rehabilitation setting.Neurology. 1996; 47 (Available at): 388-392http://www.ncbi.nlm.nih.gov/pubmed/8757009Date accessed: October 20, 2017
- Do lesion site and severity predict deficits in attentional control after preschool traumatic brain injury (TBI)?.Brain Inj. 2007; 21 (Available at): 279-292http://www.tandfonline.com/doi/full/10.1080/02699050701253095Date accessed: October 20, 2017
- D02/S/a NHS standard contract for specialised rehabilitation for patients with highly complex needs (all ages).(Available at)https://www.england.nhs.uk/wp-content/uploads/2014/04/d02-rehab-pat-high-needs-0414.pdfDate: 2013Date accessed: December 26, 2017
- The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis.Psychol Methods. 1996; 1 (Available at): 16-29
- SPSS for Windows step by step: a simple guide and reference, 17.0 update.Pearson, 2010
- Structural equation models with non-normal variables: Problems and remedies.in: HR H. Structural equation modeling: concepts, issues, and applications. Sage, 1995: 56-75
- Factor analysis.2nd ed. Lawrence Erlbaum Associates, 1983
- Comparison of five rules for determining the number of components to retain.Psychol Bull. 1986; 99: 432-442
- Evaluating the use of exploratory factor analysis in psychological research.Psychol Methods. 1999; 4 (Available at): 272-299
- Principal components and factor analysis.in: Tabachnick B.G. Fidell L.S. Using multivariate statistics. Pearson Education, Harlow2014: 659-730
- On selecting indicators for multivariate measurement and modelling with latent variables: when “good” indicators are bad and “bad” indicators are good.Psychol Methods. 1999; 4: 192-211
- Effects of variable and subject sampling on factor pattern recovery.Psychol Methods. 1998; 3: 231-251
- Structural equation modelling: Adjudging model fit.Pers Individ Dif. 2007; 42: 815-824
- Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model.A Multidiscip J. 1999; 6: 1-55
- Principles and practice of structural equation modeling.2nd ed. Guilford Press, 2005
- Significance tests and goodness-of-fit in the analysis of covariance structures.Psychol Bull. 1980; 88: 588-606
- Cutoff criteria for fit indices in covariance structure analysis: conventional criteria versus new alternatives.Struct Equ Model. 1999; 6 SRC-G: 1-55
- Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model.A Multidiscip J. 2002; 9: 233-255
- How large can a standardized coefficient be?.(Available at)http://www.ssicentral.com/lisrel/techdocs/HowLargeCanaStandardizedCoefficientbe.pdfDate: 1999Date accessed: December 16, 2017
- A power primer.Psychol Bull. 1992; 112: 155-159
- Functional outcome 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status.J Int Neuropsychol Soc. 2008; 14 (Available at): 233-242http://www.ncbi.nlm.nih.gov/pubmed/18282321Date accessed: December 16, 2017
- Predicting the outcome of acute stroke: prospective evaluation of five multivariate models and comparison with simple methods.J Neurol Neurosurgery, Psychiatry. 1992; 55 (Available at): 347-351http://jnnp.bmj.com/content/jnnp/55/5/347.full.pdfDate accessed: December 3, 2017
- Prediction of function after stroke: a critical review.Stroke. 1986; 17: 765-776
Article info
Publication history
Published online: April 28, 2018
Footnotes
This research was not supported by any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
