Functional measures after traumatic brain injury: Ceiling Effects of FIM, FIM+FAM, DRS, and CIQ

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Article in a special issue dedicated to research findings from the National Institute of Disability and Rehabilitation Research (NIDRR) Traumatic Brain Injury Model Systems (TBIMS). (See AN XJ32562 to XJ32568 for the articles.) This article describes a study that examined the characteristics of selected functional measures used to monitor progress in traumatic brain injury (TBI) patients: the Functional Independence Measure (FIM), the FIM and Functional Assessment Measure (FIM+FAM), the Disability Rating Scale (DRS), and the Community Integration Questionnaire (CIQ). The study focused on "ceiling effects," or how well each instrument detects meaningful change in functional level after rehabilitation discharge. Data for 612 patients were collected prospectively at admission and discharge from acute inpatient rehabilitation and at years 1 and 2 after injury. Results demonstrated ceiling effects for the FIM, FIM+FAM, and two of the three CIQ subscales, indicating that these measures are not as sensitive to change as may be needed to assess progress in important areas of functioning for the TBI population.

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