Authors

  1. Seel, Ronald T. PhD
  2. Wright, Greg MS, CRC, CCM
  3. Wallace, Tracey MS, CCC-SLP
  4. Newman, Sary PT
  5. Dennis, Leanne BA, CTRS, CCM

Article Content

Objectives: Examine the sensitivity of the FIM+FAM as a primary outcome measure for comprehensive day program services. Hypotheses: (1) FAM items will demonstrate low ceiling effects (below 33%) at day program admission; and (2) current day program admission FIM+FAM mean total score and ceiling effect will be lower than those reported by Hall et al1 at acute rehabilitation discharge. Participants:N = 111 clients with moderate to severe traumatic brain injury (TBI) (M age = 31.9; 72% male; 80% Caucasian; mean education = 12.8 years) who were admitted to comprehensive day program services within 9 months of injury. Methods: Retrospective clinical data were analyzed. FIM+FAM ceiling effects were defined as the proportion of clients with a 6 or 7 on each item and an average item rating of 6 or above on total scores (per Hall et al1). Results: Six FAM items were below the 33% threshold with community mobility (4%), employability (9%), and adjustment (12%) being the lowest. Only 3 FAM items had ceiling effects above 42%. Day program admission mean FIM+FAM score 146.3 (SD = 28.2) and 13% ceiling effect was lower than the acute rehabilitation discharge mean FIM+FAM score 165.1 (SD = 34.3) and 34% ceiling effect reported by Hall et al.1Conclusions: The FIM+FAM demonstrated score distributions that provide evidence of sensitivity in a day program setting. Lower scores and ceiling effects likely reflect shifting of service delivery from acute to day program settings. Future research should examine scale content using Item Response Theory.

 

REFERENCE

 

1. Hall KM, Mann N, High W, Wright J, Kreutzer J, Wood D. Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS, and CIQ. J Head Trauma Rehabil. 1996;11(5):27-39. [Context Link]