A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models

Arch Phys Med Rehabil. 2018 Sep;99(9):1805-1810. doi: 10.1016/j.apmr.2018.04.005. Epub 2018 Apr 30.


Objective: To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients.

Design: Criterion standard.

Setting: A National Health Service acute acquired brain injury inpatient rehabilitation hospital.

Participants: Referred sample of adults (N=447) admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitation INTERVENTION: Not applicable.

Outcome measure: Functional Independence Measure and Functional Assessment Measure.

Results: Exploratory factor analysis suggested a 2-factor structure to FIM+FAM scores, among both focal-proximate and diffuse-proximate acquired brain injury aetiologies. Confirmatory factor analysis suggested a 3-factor bifactor structure presented the best fit of the FIM+FAM score data across both aetiologies. However, across both analyses, a convergence was found towards a general factor, demonstrated by high correlations between factors in the exploratory factor analysis, and by a general factor explaining the majority of the variance in scores on confirmatory factor analysis.

Conclusions: Our findings suggested that although factors describing specific functional domains can be derived from FIM+FAM item scores, there is a convergence towards a single factor describing overall functioning. This single factor informs the specific group factors (eg, motor, psychosocial, and communication function) after brain injury. Further research into the comparative value of the general and group factors as evaluative/prognostic measures is indicated.

Keywords: Brain injuries; Factor analysis; Rehabilitation; Treatment outcome.

MeSH terms

  • Activities of Daily Living
  • Adult
  • Brain Injuries / psychology
  • Brain Injuries / rehabilitation*
  • Brain Injuries, Diffuse
  • Disability Evaluation*
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical*
  • Neurological Rehabilitation / statistics & numerical data*
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Psychometrics