LAUSR

Introduction/Background The usefulness of Functional Independence Measure (FIM®) scores was questioned by several previous research due to its multidimensional factor structure. The FIM® has been widely used amongst people with spinal cord injury (SCI). Previous evidence on FIM® validity amongst people with SCI is scarce. A few studies have reported that FIM® has substantial ceiling effect in a cognitive area, a possible item redundancy in a motor area, and poor psychometrics assessed by the Rasch analysis. Based on the Rasch analysis, the FIM® motor score was not recommended for use, at least as a raw sum of items’ scores. The cognitive scale was found to work well except for considerable ceiling effect. The aim was to evaluate the factor structure of FIM® scale amongst people with SCI. Material and method The 155 people with SCI participated in multidisciplinary inpatient rehabilitation. FIM® was assessed at the beginning and at the end of intervention. Retrospective register-based study. Cronbach's alpha and exploratory factor analysis. Results The internal consistency demonstrated a high Cronbach's alpha of 0.95 to 0.96. For both pre- and post-intervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items (‘walking or using a wheelchair’ and ‘expression’), the structures of the identified three factors remained the same at the beginning and at the end of rehabilitation. The loadings of all the items were sufficient exceeding 0.3. Both pre- and post-intervention chi-square tests showed significant P-values  Conclusion Within the sample of people with SCI, FIM® failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that was unstable depending on the timing of measurement. Using a total or subscale FIM® scores seem to be unjustified in the studied population.