The UK FAM

The original FAM was developed by clinicians at the Santa Clara Valley Medical Center (SCVMC) in San Jose, California, in the late 1980's. A number of brain injury units in the UK were interested in using the FIM+FAM as a common language measure, but some of the FAM items were felt to be too vague and subjective to be useful in the original form.

In 1995 a UK FIM+FAM users group therefore set out to develop the UK version of the FAM, keeping the 7-level structure, but attempting to improve the objectivity of scoring, especially for ten of the more subjective items of the twelve. This work has been undertaken in collaboration with SCVMC. The Chair of the 28 center users group is Lynne Turner-Stokes, M.D., Regional Rehabilitation Unit, Northwick Park Hospital, in Harrow, England.

The UK version of the FIM+FAM is also designed for measuring disability in the brain injured population. The FIM data can be extracted and used on its own, for example, when making comparisons with populations in which only the FIM is rated. For this reason it is important to score the FIM items as for the stand-alone scale, and the FAM items as an add-on. Certain items contain overlapping information. For example, "Eating" is a FIM item and includes swallowing, while "Swallowing" alone is a FAM item. Eating should still be rated on the basis that it includes swallowing, so that the integrity of the FIM score is maintained.

Dr. Turner-Stokes and colleagues in the UK found that overall scoring accuracy of vignettes for 37 individuals and 11 teams was improved for the UK version over the original FAM on the ten "troublesome" items (excluding Swallowing and Orientation):

	Original Version	UK Version
Accuracy of individual raters	69.5%	74.6%
Accuracy of team scores	78.2%	84.1%

UK training vignettes and a syllabus with definitions and decision trees are available that reflect the changes in the UK FAM item definitions. For example, the most obvious change is in the original FAM item "Employability," now defined as "Use of Leisure Time."

To obtain more information on the UK FAM, contact:

Dr. Lynne Turner Stokes
Regional Rehabilitation Unit
Northwick Park Hospital
Watford Road
Harrow, Middlesex, UK
HA13UJ

Phone: +44 (0)181-869-2800
Fax: +44 (0)181-869-2803
email: lynne.turner-stokes@dial.pipex.com