Barthel Index for Stroke Trials

Abstract

Background and Purpose-Robust measures of functional outcome are required to determine treatment effects in stroke trials. Of the various measures available, the Barthel index (BI) is one of the more prevalent. We aimed to describe validity, reliability, and responsiveness (clinimetric properties) of the BI in stroke trials. Methods-Narrative review of published articles describing clinimetric properties or use of the BI as a stroke trial end point. Results-Definitive statements on properties of BI are limited by heterogeneity in methodology of assessment and in the content of "BI" scales. Accepting these caveats, evidence suggests that BI is a valid measure of activities of daily living; sensitivity to change is limited at extremes of disability (floor and ceiling effects), and reliability of standard BI assessment is acceptable. However, these data may not be applicable to contemporary multicenter stroke trials. Conclusions-Substantial literature describing BI clinimetrics in stroke is available; however, questions remain regarding certain properties. The "BI" label is used for a number of instruments and we urge greater consistency in methods, content, and scoring. A 10-item scale, scoring 0 to 100 with 5-point increments, has been used in several multicenter stroke trials and it seems reasonable that this should become the uniform stroke trial BI. (Stroke. 2011;42:1146-1151.)

The predictive value of selected functional and clinical parameters in stroke rehabilitation

“…in mRS) it was 7.46, and the median -7.00. This is consistent with the review of publications by Quinn et al in 2011 [12]. Despite the existing reservations concerning the heterogeneity of the evaluation methodology and the limited sensitivity in case of extreme values (floor and ceiling effects), BI is recommended for general use in patients with strokes, and at the same time it is one of the most widely used to assess the functional status after stroke [13].…”

Derivation and Validation of a Modified Short Form of the Stroke Impact Scale

“…This size of data set is considerably larger than that for most previous work concerning derivation and validation of novel stroke outcomes 10, 24. As well as deriving the SF‐SIS, VISTA data allowed us to explore properties of the original SIS with an unprecedented precision.…”

“…The rehabilitation data set had fewer participants than the acute data set. The smaller data set may limit power and external validity, although our sample size is still much larger than that of most psychometric studies of stroke scales 10, 24…”

Is the Barthel Index an Adequate Assessment Tool for Identifying a Risk Group in Elderly People Living at Home?

“…The nursing assessment consisted of three parts [18]. Based on the theoretical model of the WHO-ICF classification [22], part 1 of the nursing assessment focused on the activities which were measured with the BI [13] according to the Hamburg Classification Manual and the IADL Index [25].…”

“…The BI expresses the degree of independence of a person by means of a total score (TC) [18]. The scale ranges from zero (0) to 100, whereby 0 means total dependence and 100 complete independence in the assessed dimensions.…”