Measuring changes in functional ability in older children and young people with acquired brain injury using the UK FIM plus FAM

Introduction There is a need for validated and responsive measurement tools to demonstrate changes in functional ability. Existing outcome measurement tools have significant limitations for children and young people with acquired brain injury (ABI). Aim This study examines the potential of the UK Functional Independence Measure+Functional Assessment Measure (UK FIM+FAM) to detect clinical change in older children and young people with ABI. Method This is a secondary retrospective pretest-post test analysis of 72 children and young people age 8-17 years. Internal responsiveness was examined using Wilcoxon signed-rank tests and effect sizes indices; external responsiveness was examined in relation to the Neurological Impairment Scale (NIS) using Spearman's correlation coefficient. Results Highly significant changes were detected from admission to discharge on motor, cognitive and total UK FIM+FAM scores (p<0.001). Medium to large effect sizes were found on the total scale indicating good internal responsiveness. There was a significant, negative correlation between UK FIM+FAM change scores and NIS change scores (p<0.01) indicating good external responsiveness. Conclusion The UK FIM+FAM was able to detect clinically meaningful change in functional ability in children and young people with ABI over 8 years. Further validity and reliability must be established before recommending its use in this client group.