Brain Injury Functional Outcome Measure (BI-FOM): A Single Instrument Capturing the Range of Recovery in Moderate-Severe Traumatic Brain Injury

John Whyte*, Joseph T. Giacino, Allen W. Heinemann, Yelena Bodien, Tessa Hart, Mark Sherer, Gale G. Whiteneck, David Mellick, Flora M. Hammond, Patrick Semik, Amy Rosenbaum, Risa Nakase Richardson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To develop a measure of global functioning after moderate-severe TBI with similar measurement precision but a longer measurement range than the FIM. Design: Phase 1: retrospective analysis of 5 data sets containing FIM, Disability Rating Scale, and other assessment items to identify candidate items for extending the measurement range of the FIM; Phase 2: prospective administration of 49 candidate items from phase 1, with Rasch analysis to identify a unidimensional scale with an extended range. Setting: Six TBI Model System rehabilitation hospitals. Participants: Individuals (N=184) with moderate-severe injury recruited during inpatient rehabilitation or at 1-year telephone follow-up. Interventions: Participants were administered the 49 assessment items in person or via telephone. Main Outcome Measures: Item response theory parameters: item monotonicity, infit/outfit statistics, and Factor 1 variance. Results: After collapsing misordered rating categories and removing misfitting items, we derived the Brain Injury Functional Outcome Measure (BI-FOM), a 31-item assessment instrument with high reliability, greatly extended measurement range, and improved unidimensionality compared with the FIM. Conclusions: The BI-FOM improves global measurement of function after moderate-severe brain injury. Its high precision, relative lack of floor and ceiling effects, and feasibility for telephone follow-up, if replicated in an independent sample, are substantial advantages.

Original languageEnglish (US)
Pages (from-to)87-96
Number of pages10
JournalArchives of physical medicine and rehabilitation
Issue number1
StatePublished - Jan 2021


  • Assessment
  • Brain injuries
  • Outcome Measurement
  • Patient outcome
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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