Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge

Reis, Nair Fritzen dos; Figueiredo, Fernanda Cabral Xavier Sarmento de; Biscaro, Roberta Rodolfo Mazzali; Lunardelli, Elizabeth Buss; Silva, Rosemeri Maurici da

doi:10.4037/ajcc2022732

Cited by 13 publications

(13 citation statements)

References 33 publications

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“…How does the study by Stripari Schujmann et al (1) compare with others measuring the BI? In a cohort of 122 general ICU patients from the pre-COVID era, the median (interquartile range [IQR]) BI score at ICU discharge was 25 (10–60; rater 1) (3). In the seminal randomized clinical trial of early physical therapy and occupational therapy, the median (IQR) BI scores at hospital discharge for those who started rehabilitation within 72 hours of ICU admission was 75 (IQR 7.5–95), and those in the control group 55 (0–85) (4).…”

Section: Contextualizing the Resultsmentioning

confidence: 99%

The Importance of Rehabilitation for Functional Recovery and Long-Term Outcomes for Recovery From Critical COVID-19 Illness*

Rewa¹,

Kho²

2022

Critical Care Medicine

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I n this issue of Critical Care Medicine, Stripari Schujmann et al (1) described a prospective, multicenter study analyzing the trajectory of critically ill patients with COVID-19 during their critical care illness. It described the disease course of 328 survivors admitted between July 2020 and July 2021 across four ICUs in Sao Paulo, Brazil. The primary outcome was the Barthel Index (BI) measured at ICU and at hospital discharge. Secondary outcomes included duration of mechanical ventilation, ICU and hospital length of stay (LOS), muscle and hand grip strength, development of ICU-acquired weakness, and mobility milestones including time to out of bed and ambulation. Documented ICU exposures included mechanical ventilation, sedation, renal replacement therapy, proning, and receipt of physical therapy. The authors excluded patients who died in hospital, had a short ICU stay (i.e., < 4 d), those who had a functional decline due to other complications, and those who could not participate with their assessment.The cohort was functionally independent at baseline (i.e., BI = 100 points, described further below), relatively young (i.e., mean [sd] 55.3 (14.7) yr), and had ICU and hospital LOS of 13.9 (11.2) and 25.6 (23.0) days, respectively. Patients were quite sick with a Simplified Acute Physiology Score (SAPS)-3 score of 51.2 (16.5). Just over half of the cohort (i.e., 52.8%) received mechanical ventilation for 9.3 (8.2) days and accompanying sedation for 7.4 (6.0) days; 35.4% received neuromuscular blockade, and 33% of patients required proning during their ICU stay. The majority of the cohort (93.8%) received corticosteroids, and 11.2% required renal replacement therapy. Although no data were available on nutritional status, 56.3% of patients had reported hyperglycemia during this ICU stay. Mobility was recorded as the time to out-of-bed patient mobilization from ICU admission.The authors identified three outcome states at hospital discharge based on BI class. The BI was a marker of functionality that included an assessment of 10 activity and mobility activities, where each item's rating reflected the amount of assistance required to complete an activity. Scores vary from 0 to 100, where higher scores reflect better function (2). It is valid and reliable for use in ICU survivors, the smallest detectable change at ICU discharge is 20 points, and scores greater than 85 reflect mild to no impairment (2). In the study by Stripari Schujmann et al (1), the authors found that 44% of included patients were functionally independent (BI score > 85 at ICU and hospital discharge), 33% recovered functionality (BI score < 85 at ICU discharge and

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Section: Contextualizing the Resultsmentioning

confidence: 99%

The Importance of Rehabilitation for Functional Recovery and Long-Term Outcomes for Recovery From Critical COVID-19 Illness*

Rewa¹,

Kho²

2022

Critical Care Medicine

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“…In this sense, other studies have validated the Barthel Index for other populations. A study carried out with the Brazilian population investigated the measurement properties of the Barthel Index in intensive care unit discharge and observed adequate internal consistency (Cronbach's alpha = 0.81), acceptable reliability (ICC = 0.98), and moderate to high correlations with other physical functioning measurement instruments (rho = 0.57 to 0.88) [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Barthel Index is a valid and reliable tool to measure the functional independence of cancer patients in palliative care

et al. 2022

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Background Our objective was to verify the reliability, internal consistency and construct validity of the Barthel Index in Brazilian cancer patients in palliative care. Methods We included patients with cancer, both sexes, and age greater than or equal to 18 years. We used to evaluate patients the Barthel Index, Karnofsky Performance Scale (KPS), and European Organization for Research in the Treatment of Cancer Questionnaire-core 15 (EORTC-QLQ-C15-PAL). The measurement properties evaluated in this study were test–retest and inter-rater reliability and construct validity (tested by means of correlations with other instruments). Results We included 220 patients for construct validity and a subsample of 27 patients for reliability analyses. We observed adequate reliability (intraclass correlation coefficient ≥ 0.962) and internal consistency (Cronbach’s alpha = 0.942). There were adequate correlations between the Barthel Index and the KPS (rho = 0.766), and the functional capacity domain of the EORTC-QLQ-C15-PAL (rho = -0.698). Conclusion The Brazilian version of the Barthel Index presents adequate test–retest and inter-rater reliability, acceptable internal consistency, and valid construct for measuring functional independence in cancer patients.

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“…It showed su cient inter-rater reliability (ICC 0.98) and good internal consistency (Cronbach's α 0.81) supported by a low certainty of evidence but was rated indeterminate for internal consistency due to no information on structural validity (52). Su cient construct validity was supported by a high certainty of evidence (52,54). Su cient responsiveness was demonstrated in a single study with a very low certainty of evidence (51).…”

Section: Activities Of Daily Livingmentioning

confidence: 96%

“…Four studies reported data for the Barthel Index (51)(52)(53)(54). It showed su cient inter-rater reliability (ICC 0.98) and good internal consistency (Cronbach's α 0.81) supported by a low certainty of evidence but was rated indeterminate for internal consistency due to no information on structural validity (52). Su cient construct validity was supported by a high certainty of evidence (52,54).…”

Section: Activities Of Daily Livingmentioning

confidence: 99%

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A systematic review and meta-analysis of the clinimetric properties of the core outcome measurement instruments for clinical effectiveness trials of nutritional and metabolic interventions in critical illness (CONCISE)

Davies,

Kelly,

Gassel

et al. 2023

Preprint

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Background: CONCISE is an internationally agreed minimum set of outcomes for use in nutritional and metabolic clinical research in critically ill adults. Clinicians and researchers need to be aware of the clinimetric properties of these instruments and understand any limitations to ensure valid and reliable research. This systematic review and meta-analysis were undertaken to evaluate the clinimetric properties of the measurement instruments identified in CONCISE. Methods: Four electronic databases were searched from inception to December 2022 (MEDLINE via Ovid, EMBASE via Ovid, CINAHL via Healthcare Databases Advanced Search, CENTRAL via Cochrane). Studies were included if they examined at least one clinimetric property of a CONCISE measurement instrument or recognised variation in adults ≥ 18 years with critical illness or recovering from critical illness in any language. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for systematic reviews of Patient-Reported Outcome Measures was used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in line with COSMIN guidance. The COSMIN checklist was used to evaluate the risk of bias and the quality of clinimetric properties. Overall certainty of the evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation approach. Narrative synthesis was performed and where possible, meta-analysis was conducted. Results: A total of 4316 studies were screened. Forty-seven were included in the review, reporting data for 12308 participants. The Short Form-36 Questionnaire (Physical Component Score and Physical Functioning), sit-to-stand test, 6-metre walk test and Barthel Index had the strongest clinimetric properties and certainty of evidence. The Short Physical Performance Battery, Katz Index and handgrip strength had less favourable results. There was limited data for Lawson Instrumental Activities of Daily Living and the Global Leadership Initiative on Malnutrition criteria. The risk of bias ranged from inadequate to very good. The certainty of the evidence ranged from very low to high. Conclusions: Variable evidence exists to support the clinimetric properties of the CONCISE measurement instruments. We recommend using this review alongside CONCISE to guide outcome selection for future trials of nutrition and metabolic interventions in critical illness. Trial registration: PROSPERO (CRD42023438187). Registered 21/06/2023.

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Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge

Cited by 13 publications

References 33 publications

The Importance of Rehabilitation for Functional Recovery and Long-Term Outcomes for Recovery From Critical COVID-19 Illness*

The Importance of Rehabilitation for Functional Recovery and Long-Term Outcomes for Recovery From Critical COVID-19 Illness*

Barthel Index is a valid and reliable tool to measure the functional independence of cancer patients in palliative care

A systematic review and meta-analysis of the clinimetric properties of the core outcome measurement instruments for clinical effectiveness trials of nutritional and metabolic interventions in critical illness (CONCISE)

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