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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Activity Index - a complementary ADL scale to the Barthel Index in the acute stage in patients with severe stroke
Louise Martinsson1, Staffan Eksborg
1Institution of Clinical Neurosciences, Karolinska Institutet and the Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Objective:
It was the aim of this study to compare the Barthel Index (BI) and the activities of daily living (ADL) component of the Activity Index [AI(ADL)] regarding floor and ceiling effects, responsiveness and the predictive value for survival during the first week until 3 months after stroke onset.
Patients And Methods:
Basic ADL were assessed in 75 patients with ischaemic stroke.
Results:
There was a strong concordance between BI and AI(ADL) scores at all time points (Kendall's taub = 0.7878, p < 0.0001 at baseline; Kendall's taub = 0.8901, p < 0.0001 at 1 week; Kendall's taub = 0.9027, p < 0.0001 at 3 months). BI had a significantly more pronounced floor effect at baseline and at 1 week compared with AI(ADL) in patients with severe stroke. Both scales had a substantial ceiling effect at 3 months. At 1 week, the baseline BI score was significantly higher in patients being alive as compared with those who had died, while their AI(ADL) score did not differ significantly. At 3 months, baseline BI and AI(ADL) scores were significantly higher in patients being alive as compared with those who had died. The predictive value of being alive at 1 week and 3 months did not differ between BI and AI(ADL).
Conclusion:
AI(ADL) is recommended to be used in addition as a complement to BI in patients with severe stroke since the floor effect with BI in the acute stage is significantly more pronounced than with AI(ADL), thus hampering the responsiveness.
