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RehabMeasures Instrument

Functional Assessment Measure

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The FAM consists of 12 items added on to FIM to enhance its utility for the brain injury population. These items do not stand alone, but are intended to be added to the 18 items of the FIM.

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Instrument Details

Acronym FAM




  • Brain Injury Recovery
  • Multiple Sclerosis
  • Stroke Recovery

Key Descriptions

  • The FAM consists of 12 items. These items do not stand alone, but are intended to be added to the 18 items of the FIM. The total 30 item scale combination is referred to as the FIM+FAM.
  • Tasks are rated on a 7 point ordinal scale that ranges from total assistance (or complete dependence) to complete independence.
  • Scores are generally rated at admission and discharge.
  • The 12 + 18 Dimensions assessed include:
    1) Swallowing
    2) Car transfer
    3) Community access
    4) Reading
    5) Writing
    6) Speech intelligibility
    7) Emotional status
    8) Adjustability to limitations
    9) Employability
    10) Orientation
    11) Attention
    12) Safety judgement
  • Wright, J. (2000). The Functional Assessment Measure. The Center for Outcome Measurement in Brain Injury. ( accessed June 3, 2012).

    Note: This citation is for the COMBI web material. Mr. Wright is not the scale author for the FAM.

Number of Items

FAM: 12
FIM: 18

Equipment Required

  • Check flow chart for specific items, but may need food to assess swallow, car, reading materials, writing materials, etc.

Time to Administer

45 minutes

30-45 minutes

Required Training

Training Course

Instrument Reviewers

Initially reviewed by Tammie Keller Johnson, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 8/2012

ICF Domain

Body Structure
Body Function

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:




Highly Recommend




Reasonable to use, but limited study in target group / Unable to Recommend


Not Recommended


Recommendations based on level of care in which the assessment is taken:


Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility



Home Health








Recommendations for use based on ambulatory status after brain injury:


Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant







Recommendations for entry-level physical therapy education and use in research:



Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)





Not reported


  • The published articles are based on ideal conditions, i.e., each rater is receiving the same information and sufficient information on the patient to do the rating, and each rater is trained and is using the definitions of terms in the Decision Tree in making ratings (Hall et al., 1992)

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Brain Injury

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Cut-Off Scores

Traumatic Brain Injury: (Grauwmijer et al, 2012; n=113; mean age = 33.2 (13.1) years; moderate TBI =26% and severe TBI = 74%)

  • A FAM cut off score of < 65 to identify patients at risk of long-term unemployment had a good diagnostic value (odds ratio 6.9; 95% confidence interval, 2.5-19.4). Had a sensitivity of 75%, specificity of 70%, positive predictive value of 65% and negative predictive value of 79%.

Normative Data

Traumatic Brain Injury: (Hall et al, 1996; n=80 cases with FIM+FAM data, acute rehab to 2 years post injury)





1 year

2 year


FIM + FAM Cognitive (N = 80; Max = 98)










FIM + FAM;Motor (N = 80 Max = 112)










FIM + FAM total









Test/Retest Reliability

Traumatic Brain Injury: (Powel et al., 2005; n=56; mean age = 42 years; standard deviation = 14 years)

  • Excellent test-retest reliability: ranged 0.84-0.97

Interrater/Intrarater Reliability

Traumatic Brain Injury: (Mcpherson et al., 1996; n=54; 76% male; traumatic brain injury patients)

  • Excellent interrater reliability: good (kappa values = 0.50 to 0.95) for all but one of the 30 items rated on the FIM+FAM
  • The exception (with a kappa = 0.35) was "adjustment to limits"
  • Higher agreement was found for rating of physical activities than for cognitive, communication and behavioral items


Traumatic Brain Injury: (Law et al, 2009; Twelve allied health professionals from two neurorehabilitation units: four occupational therapists, four physiotherapists and four nurses)

  • Inter-rater agreement across all items at test time 1 was 83% (k=0.80) for individuals and 91% (k=0.90)


Traumatic Brain Injury: (Donaghy et al., 1998; mean age = 38 yo; Severe TBI n=53 (40 men, 13 women))

  • ICC >.60 for 29 of 30 items
  • Poor: Social Interaction (ICC=0.36)
  • Adequate: The next poorest correlation was FAM item Emotional Status (ICC=0.62)
  • Adequate: The addition of FAM items to the cognitive/psychosocial domain increased reliability of this subscale to 0.74 from 0.69 for the FIM items alone.
  • Excellent: For the 18 FIM items (ICC=0.85) vs. for 30 FIM+FAM items ( ICC=0.83)


Traumatic Brain Injury: (Law et al., 2008; Twelve Allied Health Professionals from two neurorehabilitation units (four occupational therapists, four physiotherapists and four nurses)

  • Excellent intra-rater agreement: across all items between test times 1 and 2 was 87% (Weighted Kappa= 0.93) for individuals and 94% (Weighted Kappa = 0.97)

Internal Consistency

TBI: (Hawley et al; n=652, traumatic brain injury patients from 3 sites in Scotland)

  • Excellent internal consistency: Cronbach’s alpha = 0.99 complete measure. Physical=0.98; Cognitive= .99 


Criterion Validity (Predictive/Concurrent)

Traumatic Brain Injury: (Hall et al., 1993; n=332 patients with TBI; TBI Model systems)

  • FAM items rated at rehabilitation admission correlated significantly with indices of injury severity in a very similar pattern as FIM items. 


Traumatic Brain Injury: (Seel et al., 2007; n=105; moderate or severe TBI; mean age = 31.8 years (median = 26; SD = 13.9; range = 16–69))

  • Predictive validity of FIM+FAM motor scores for physical therapy referrals:


Referred for PT




Yes (n = 48)

No (n = 57)

Below ceiling (n = 62)



Above ceiling (n = 43)



∗Sensitivity indicates 0.88; specificity, 0.65; positive predictive value, 0.68; and negative predictive value, 0.86

Construct Validity

Traumatic Brain Injury: (Hawley et al. 1999; n=652, traumatic brain injury patients from 3 sites in Scotland)

  • Construct validity: FIM+FAM not unidimensional -- factor analysis demonstrated 2 principal components with eigen values > 1 – 16 items reflect physical functioning and 14 items reflect cognition, language and psychosocial functioning


Traumatic Brain Injury: (Gurka et al. 1999; ABIEBR website) 

  • Linear regression analysis revealed FIM+FAM cognition scores at 6 months explained 33% of variance in CIQ scores at 6 months post-discharge while FIM+FAM motor scores accounted for 22% of variance
  • This was compared to FIM cognition & motor scores that accounted for 31% & 21% of the variance, respectively

Floor/Ceiling Effects

Traumatic Brain Injury: (Gurka et al. 1999; n=167)

  • 80 – 90% of patients obtained “near maximum” scores on the FAM


Traumatic Brain Injury: (Hall et al. 1993; ABIEBR website) 

  • Rasch analysis revealed FAM items cover a wider range of difficulty than the FIM items and, therefore, expand the range of scale difficulty beyond the FIM alone
  • Both FIM and FAM items tend to cluster in the mid-range 


Traumatic Brain Injury: (TBI Model System National Database, Hall et al., 1996; Combi site; ABIEBR)

  • When ceiling effect is defined at scoring 180 on the FIM + FAM, 34% of patients scored in the ceiling range at discharge from rehabilitation and 79% at one year post discharge
  • This represented an improvement over the FIM (49%, 84%) – there was no advantage in terms of ceiling effect seen with regard to cog-FIM and the cognitive items of the FIM+FAM
  • There is evidence that the FAM at rehabilitation discharge has less "ceiling effect" than the FIM and is more strongly related to rehabilitation charges than the FIM

Non-Specific Patient Population

back to Populations

Interrater/Intrarater Reliability

Interrater Agreement: (Hall et al., 1992)

  • Preliminary data suggest that FAM items involving abstract concepts such as "attention" tend to be less reliable than directly observable behaviors
  • The percentage of rating agreement was 89%
  • Excellent: Kappa score for the FIM =0.87, and for the FAM Kappa = 0.85
  • Individual raters (OT, PT, COTA, researcher, data analyzer) ranged in agreement with the "correct answer," from a high of 94% to a low of 81% of composite percentages across items


Neurological disorders: (Hobart et al, 2001; n=149; stroke, MS, head injury and other)

  • Excellent: FIM +FAM total= 0.98
  • Excellent: FIM+FAM motor= 0.98
  • Excellent: FIM + FAM cognitive=0.97

Internal Consistency

Neurological Rehabilitation patients: (Hobart et al, 2001; n=149; stroke, MS, head injury and other)

  • FAM is suitable for several central nervous system conditions, as it verifies the level of global disability as a result of cognitive deficits
  • Excellent internal consistency: Cronbach's alpha = 0.96 Total FIM + FAM; 0.96 Motor-FIM + FAM; 0.91 Cognitive FIM + FAM.

Content Validity

“The FAM items were developed by clinicians representing each of the disciplines in an inpatient rehabilitation program. The FAM was developed as an adjunct to the FIM to specifically address the major functional areas that are relatively less emphasized in the FIM, including cognitive, behavioral, communication and community functioning measures” (COMBI website).


Rehabilitation patients: (Hobart et al., 2001; n=149 patients; stroke, MS, head injury and other)

  • Small to moderate: SRM means for FIM+FAM total, motor FIM+FAM and cognitive FIM+FAM were reported to be 0.42, 0.52 and 0.19 respectively – there were no significant floor or ceiling effects reported for FIM+FAM.


Alcott, D., Dixon, K., et al. (1997). "The reliability of the items of the Functional Assessment Measure (FAM): differences in abstractness between FAM items." Disabil Rehabil 19(9): 355-358. Find it on PubMed

Cifu, D. X., Kreutzer, J. S., et al. (1999). "Etiology and incidence of rehospitalization after traumatic brain injury: a multicenter analysis." Arch Phys Med Rehabil 80(1): 85-90. Find it on PubMed

Dodds, T. A., Martin, D. P., et al. (1993). "A validation of the functional independence measurement and its performance among rehabilitation inpatients." Arch Phys Med Rehabil 74(5): 531-536. Find it on PubMed

Donaghy, S. and Wass, P. J. (1998). "Interrater reliability of the Functional Assessment Measure in a brain injury rehabilitation program." Arch Phys Med Rehabil 79(10): 1231-1236. Find it on PubMed

Felmingham, K. L., Baguley, I. J., et al. (2001). "A comparison of acute and postdischarge predictors of employment 2 years after traumatic brain injury." Arch Phys Med Rehabil 82(4): 435-439. Find it on PubMed

Grauwmeijer, E., Heijenbrok-Kal, M. H., et al. (2012). "A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury." Arch Phys Med Rehabil 93(6): 993-999. Find it on PubMed

Gray, D. S. and Burnham, R. S. (2000). "Preliminary outcome analysis of a long-term rehabilitation program for severe acquired brain injury." Arch Phys Med Rehabil 81(11): 1447-1456. Find it on PubMed

Gurka, J. A., Felmingham, K. L., et al. (1999). "Utility of the functional assessment measure after discharge from inpatient rehabilitation." J Head Trauma Rehabil 14(3): 247-256. Find it on PubMed

Hall, K. (1992). "Overview of functional assessment scales in brain injury rehabilitation." NeuroRehabilitation 2(4): 98-113.