Form Structure: FIM Instrument
This form structure is an organized set of data definitions for a copyrighted form
Title:
FIM Instrument
Short Name:
FIM_Instrument
Description:
The FIM instrument, version 5.2, provides an established means of collecting rehabilitation data in a consistent manner. It allows to follow changes in the functional status of subjects from the start of rehabilitative care through discharge and follow-up. Copyright UDSMR, 1999 - 2016 Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. (https://www.udsmr.org/Default.aspx) Recommended by CDISC for TBI (TAUG TBI). TAUG TBI, Cognitive activity limitations, Physical Function, Knowledge graph, See also
Disease:
General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-22
Version:
1.3
Date Created:
2015-10-15
Owner:
Number of Data Elements:
44
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
3 | Context type | The context to which the questions were answered | ContextType | Optional | CDE |
4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Optional | CDE |
5 | Data source | Source of the data provided on the case report form | DataSource | Optional | CDE |
6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Optional | CDE |
Motor subscale (Appears Up To 3 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Visit type | The type of visit from the visit types available for this particular study | VisitTyp | Recommended | CDE |
2 | FIM instrument Motor subscale, self-care - Eating scale | Scaled ability of a subject to eat independently, as part of the Motor subscale - self-care of the FIM instrument | FIMMotorSelfCareEatingScl | Recommended | CDE |
3 | FIM instrument Motor subscale, self-care - Grooming scale | Scaled ability of a subject to groom independently, as part of the Motor subscale - self-care of the FIM instrument | FIMMotorSelfCareGroomingScl | Recommended | CDE |
4 | FIM instrument Motor subscale, self-care - Bathing scale | Scaled ability of a subject to bath independently, as part of the Motor subscale - self-care of the FIM instrument | FIMMotorSelfCareBathingScl | Recommended | CDE |
5 | FIM instrument Motor subscale, self-care - Dressing lower body scale | Scaled ability of a subject to dress lower body independently, as part of the Motor subscale - self-care of the FIM instrument | FIMMotorSelfCareDresLowBodyScl | Recommended | CDE |
6 | FIM instrument Motor subscale, self-care - Dressing upper body scale | Scaled ability of a subject to dress upper body independently, as part of the Motor subscale - self-care of the FIM instrument | FIMMotorSelfCareDresUppBodyScl | Recommended | CDE |
7 | FIM instrument Motor subscale, self-care - Toileting scale | Scaled ability of a subject to toilet independently, as part of the Motor subscale - self-care of the FIM instrument | FIMMotorSelfCareToiletingScl | Recommended | CDE |
8 | FIM instrument Motor subscale, sphincter control - Bladder management scale | Scaled ability of a subject control/manage their bladder, as part of the Motor subscale - sphincter control of the FIM instrument | FIMMotorSphContrBladderMgmtScl | Recommended | CDE |
9 | FIM instrument Motor subscale, sphincter control - Bowel management scale | Scaled ability of a subject control/manage their bowel, as part of the Motor subscale - sphincter control of the FIM instrument | FIMMotorSphContrBowelMgmtScl | Recommended | CDE |
10 | FIM instrument Motor subscale, transfers - Bed, chair, wheelchair scale | Scaled ability of a subject to transfer themselves to/from a bed, chair, wheelchair, as part of Motor subscale - transfers of the FIM instrument | FIMMotorTransfBedChairWChScl | Recommended | CDE |
11 | FIM instrument Motor subscale, transfers - Toilet scale | Scaled ability of a subject to transfer themselves to/from a toilet, as part of Motor subscale - transfers of the FIM instrument | FIMMotorTransfToiletScl | Recommended | CDE |
12 | FIM instrument Motor subscale, transfers - Tub or shower scale | Scaled ability of a subject to transfer themselves to/from tub or shower, as part of Motor subscale - transfers of the FIM instrument | FIMMotorTransfTubShowerScl | Recommended | CDE |
13 | FIM instrument Motor subscale, locomotion - Walk/wheelchair | Scaled ability of a subject to walk or use a wheelchair, as part of Motor subscale - locomotion of the FIM instrument | FIMMotorLocomotionWalkWCScl | Recommended | CDE |
14 | FIM instrument Motor subscale - Locomotion mode type | Type of locomotion used by the subject (walk/wheelchair/both), as part of Motor subscale the FIM instrument | FIMMotorLocomotionModeTyp | Recommended | CDE |
15 | FIM instrument Motor subscale, locomotion - Stairs scale | Scaled ability of a subject to walk stairs, as part of Motor subscale - locomotion of the FIM instrument | FIMMotorLocomotionStairsScl | Recommended | CDE |
Comprehension (Appears Up To 3 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Visit type | The type of visit from the visit types available for this particular study | VisitTyp | Recommended | CDE |
2 | FIM instrument Cognitive subscale, communication - Comprehension scale | Scaled ability of a subject to comprehend (auditory/visual/both), as part of Cognitive subscale of the FIM instrument | FIMCognCompehensScl | Recommended | CDE |
3 | FIM instrument Cognitive subscale, communication - Usual mode of comprehension/expression type | Type of usual mode of comprehension (auditory/visual/both), as part of Cognitive subscale of the FIM instrument | FIMCognCompehensExpressModeTyp | Recommended | CDE |
Expression (Appears Up To 3 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Visit type | The type of visit from the visit types available for this particular study | VisitTyp | Recommended | CDE |
2 | FIM instrument Cognitive subscale, communication - Expression scale | Scaled ability of a subject to express themselves, as part of Cognitive subscale of the FIM instrument | FIMCognExpressionScl | Recommended | CDE |
3 | FIM instrument Cognitive subscale, communication - Usual mode of comprehension/expression type | Type of usual mode of comprehension (auditory/visual/both), as part of Cognitive subscale of the FIM instrument | FIMCognCompehensExpressModeTyp | Recommended | CDE |
Social Cognition (Appears Up To 3 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Visit type | The type of visit from the visit types available for this particular study | VisitTyp | Recommended | CDE |
2 | FIM instrument Cognitive subscale - Social interaction scale | Scaled ability of a subject to handle social interactions, as part of Cognitive subscale of the FIM instrument | FIMCognSoclInteractScl | Recommended | CDE |
3 | FIM instrument Cognitive subscale - Problem solving scale | Scaled ability of a subject to handle problem solving, as part of Cognitive subscale of the FIM instrument | FIMCognProbSolvScl | Recommended | CDE |
4 | FIM instrument Cognitive subscale - Memory scale | Scaled ability of a subject to memorize, as part of Cognitive subscale of the FIM instrument | FIMCognMemoryScl | Recommended | CDE |
Scores (Appears Up To 3 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Visit type | The type of visit from the visit types available for this particular study | VisitTyp | Recommended | CDE |
2 | FIM instrument - Motor subscore | Motor functions subscore, as part of the Motor subscale of the FIM instrument | FIMInstrMotorSubscore | Recommended | CDE |
3 | FIM instrument - Cognitive functions subscore | Cognitive functions subscore, as part of the Cognitive subscale of the FIM instrument | FIMInstrCognFunctSubscore | Recommended | CDE |
4 | FIM instrument - Total score | Total score for the FIM instrument | FIMInstrTotalScore | Recommended | CDE |
Keywords