Differential item functioning of the Functional Independence Measure in higher performing neurological patients.

Objective: When comparing outcomes of the Functional Independence Measure (FIM[TM]) between patient groups, item characteristics of the FIM[TM] should be consistent across groups. The purpose of this study was to compare item difficulty of the FIM[TM] in 3 patient groups with neurological disorders. Subjects: Patients with stroke ( n =295), multiple sclerosis ( n =150), and traumatic brain injury ( n =88). Methods: FIM[TM] scores were administered in each group. The FIM[TM] consists of a motor domain (13 items) and a cognitive domain (5 items). Rasch rating scale analysis was performed to investigate differences in item difficulty (differential item functioning) between groups. Results: Answering categories of the FIM[TM] items were reduced to 3 (from the original 7) because of disordered thresholds and low answering frequencies. Two items of the motor domain ('bladder' and 'bowel') did not fit the Rasch model. For 7 out of the 11 fitting motor items, item difficulties were different between groups (i.e. showed differential item functioning). All cognitive items fitted the Rasch model, and 4 out of 5 cognitive items showed differential item functioning. Conclusion: Differential item functioning is present in several items of both the motor and cognitive domain of the FIM[TM]. Adjustments for differential item functioning may be required when FIM[TM] data will be compared between groups or will be used in a pooled data analysis. [ABSTRACT FROM AUTHOR]