Pediatric Functional Independence Measure (WeeFIM)

Full Name of Assessment:		WeeFIM (Pediatric Functional Independence Measure)
Author, Publisher, Date:		Carl V. Granger & Margaret A. McCabe; Uniform Data System for Medical Rehabilitation; 1990
Source:		www.udsmr.org	Pricing:$4100 in/outpatient; $2200 inpatient only
Brief description (purpose, domains, subscales, time to administer, space/equipment needs): The WeeFIM II® System allows credentialed clinicians across the United States and around the world to measure and document functional performance in infants (0-3 years old), children, and adolescents with either acquired or congenital disease in a consistent manner. The WeeFIM® instrument is a reliable outcomes measurement instrument that can be applied uniformly across inpatient, outpatient, and community-based settings to track clinical, managerial, and performance improvement efforts and initiatives. The WeeFIM II® System is a benchmarked outcomes management system that provides a method of evaluating outcomes for patients, groups of patients (population-based), and overall medical rehabilitation/habilitation programs. The WeeFIM® instrument was developed to measure the need for assistance and the severity of disability in children between the ages of 6 months and 7 years. The WeeFIM® instrument may be used with children above the age of 7 years as long as their functional abilities, as measured by the WeeFIM® instrument, are below those expected of children aged 7 who do not have disabilities. The WeeFIM® instrument consists of a minimal data set of 18 items that measure functional performance in three domains: self-care, mobility, and cognition. The WeeFIM® Instrument: 0-3 Module is a questionnaire that measures precursors to function in children 0-3 years old who have a variety of disabilities. The 0-3 module can be administered to parents by interview or self-report and is useful across many settings, including early intervention and preschool. Domain: self care eating grooming bathing dressing – upper body dressing – lower body toileting bladder management bowel management mobility transfer: chair, wheelchair transfer: toilet transfer: tub, shower walk, wheelchair, crawl stairs cognition comprehension expression social interaction problem solving memory
Scoring: Performance of the child on each of the items is assigned to one of seven levels of an ordinal scale that represents the range of function from complete and modified independence (levels 7 and 6) without a helping person to modified and complete dependence (levels 5 to 1) with a helping person.. FIM™ LEVELS No helper 7 Complete Independence (Timely, Safely) 6 Modified Independence (Device) Helper – Modified Dependence 5 Supervision (Subject = 100%) 4 Minimal assistance (Subject = 75% or more) 3 Moderate assistance (Subject = 50% or more) Helper – Complete Dependence 2 Maximal assistance (Subject = 25% or more) 1 Total assistance (Subject less than 25%)
Psychometric properties (describe briefly; e.g. reliability, validity, sensitivity, specificity, etc): Test-retest: for the six domains range from r = 0.83 to 0.99 Internal consistency (Cronbach’s alpha), ICC, and PSI values of the WeeFIM motor and cognitive scales were high (>0.90) and consistent for individual use. Interrater reliability was excellent with ICC values of 0.98 and 0.93 for the motor and cognitive scales respectively. External construct validity: The correlations of the WeeFIM scale with four areas of the Denver-II were as expected, the strongest (r=0.94) being between the WeeFIM cognitive scale and the Denver II language section, and the least strong (r=0.71) between the WeeFIM cognitive and the Denver II gross motor function section.
Citations/References (source at least 2 articles that use the tool or reports on psychometrics): Ottenbacher, K.J., Msall, M.E., Lyon, N., Duffy, L.C., Granger, C.V., & Braun, S. (1999).  Measuring developmental and functional status in children with disabilities.  Developmental Medicine & Child Neurology, 41, 186-194. Ottenbacher, K.J., Msall, M.E., Lyon, N., Duffy, L.C., Ziviani, J., Granger, C.G., Braun, S. & Feidler, R.C. (2000).  The WeeFIM instrument:  Its utility in detecting change in children with developmental disabilities.  Archive of Physical Medicine Rehabilitation, 81, 1317-1326.
Comments/critique (include application to practice – settings, needs, populations): Brief, easy to administer, discipline-free measure of disability in children with different conditions Multiple applications:  clinical, management, performance improvement, & research and development Can be utilized with children above age 7, as long as functional abilities (those measured by the instrument) are below those expected of 7-year-olds who do not have disabilities.
Training or certification requirements:	To use the FIM and WeeFIM assessors need to attend training and pass an online exam to become credentialed. Once an assessor has passed the exam, credentialing remains valid for two years, after which time the exam must be sat again.