The reliability of the items of the Functional Assessment Measure (FAM): Differences in abstractness between FAM items

Abstract

The reliability of the Functional Assessment Measure (FIM+FAM) is an important issue with its increased use in the measurement of neurological disability and rehabilitation outcome. Although the Motor items have good reliability ratings, the Cognitive items are more difficult to complete and their reliability is not as good. This study tests the suggestion that this might be due to the Cognitive items being more abstract. A keyword from each of four Motor items was compared with a keyword from four Cognitive items. Abstractness was measured by measuring the 'imageability' of each keyword. The Motor items were found to have a significantly higher mean imageability rating than the Cognitive items. Thus, there is support for the suggestion that abstractness contributes to the poorer reliability of the Cognitive items. These results led to the proposal that the reliability of the Cognitive items might be improved by various methods of increasing the tangibility of these measures (e.g. subdivision of broad categories of disabilities, enhancing item descriptions, training raters to increase their recognition of relevant observations, and using specific assessment tasks to elicit relevant behaviours).

Methods of Evaluation in a Cognitive-behavioural Rehabilitation Programme for Brain Injury: The Experience of Ticehurst House and Unsted Park Hospitals

“…For example, it is often difficult to make a distinction between "complex" and "basic" problems. Our experience has supported the evidence suggesting that abstractness may affect the reliability of certain items (Alcott, Swann, & Grafham 1997;MacPherson, Pentland, Cudmore, & Prescott, 1996). We have found the sensitivity of some of the FIM+FAM items to be insufficient.…”

Rehabilitation on a Cognitive Behavioural Unit Is Associated with Changes in FAM, not FIM

“…The FIM+FAM requires training, and interdisciplinary rating can take up to 30 minutes per client even for experienced raters. In addition, scoring guidelines for FAM items are often ambiguous (Alcott et al, 1997) and open to interpretation, and this is suspected to affect the reliability of the tool (Hall et al, 1993;McPherson, Pentland, Cudmore, & Prescott, 1996). For example, raters have to decide whether the client behaves appropriately socially more than 50% of the time.…”

“…However, there are relatively few published studies of the FIM+FAM psychometric properties (Alcott, Dixon, & Swann, 1997).…”

Partial weight-bearing gait retraining for persons following traumatic brain injury: preliminary report and proposed assessment scale

“…These scales are easy to use and have been reported to be valid [3,4] and reliable [5± 7], in part due to the level of physical and mental improvement generally needed to advance within such scales. Examples of such scales include the Standing Balance Scale, Functional Ambulation Category, Functional Independence Measure (FIM) [3,8], Functional Assessment Measure (FAM) [5,6], Community Integration Questionnaire (CIQ) [4,9], and Glascow Outcome Scale (GOS) [10]. A comprehensive list of outcome measures currently used to assess persons with TBI can be found at http://www.tbims.org/combi.html.…”