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Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients
Fang Liu1, Raymond Cc Tsang2, Jing Zhou1
1Department of Rehabilitation, Shenzhen Second People's Hospital/Health Science Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China.
Insights
This study recommends optimal cutoff scores for the Barthel Index and its Short Form to consistently assess stroke outcomes using the modified Rankin Scale. These findings improve the reliability of stroke outcome classification in clinical practice and trials.
Area of Science:
- Neurology
- Clinical Trials
- Rehabilitation Medicine
Background:
- The Modified Rankin Scale (mRS) and Barthel Index (BI) are standard tools for evaluating stroke outcomes.
- Consistent assessment of favorable outcomes using these scales is crucial for clinical practice and research.
- This study addresses the need for improved concordance between BI scores and mRS grades.
Purpose of the Study:
- To examine the relationship between Barthel Index (BI) and 3-item BI Short Form (BI-SF) scores and modified Rankin Scale (mRS) grades in acute stroke patients.
- To establish optimal cutoff scores for BI and BI-SF to accurately reflect mRS grades.
Main Methods:
- Utilized data from 516 stroke patients in a follow-up study in China.
- Compared recorded mRS grades with BI scores to derive adjusted mRS grades, accounting for potential misclassifications.
- Employed Receiver Operating Characteristic (ROC) curve analyses to determine optimal cutoff scores, sensitivities, and specificities for BI and BI-SF against adjusted mRS grades (≤1, ≤2, ≤3).
Main Results:
- Approximately 44% of recorded mRS grades required adjustment, highlighting potential inconsistencies.
- Optimal BI cutoff scores were ≥100 for mRS ≤1 and ≤2, and ≥75 for mRS ≤3.
- Optimal BI-SF cutoff scores were ≥40 for mRS ≤1 and ≤2, and ≥35 for mRS ≤3.
- ROC curve analyses demonstrated high accuracy, with areas under the curve generally exceeding 0.9.
Conclusions:
- Recommended optimal cutoff scores for BI (≥100, ≥100, ≥75) and BI-SF (≥40, ≥40, ≥35) corresponding to mRS grades ≤1, ≤2, and ≤3, respectively.
- These recommended cutoffs can enhance the consistent determination of favorable and unfavorable stroke outcomes within three months post-onset.
- The findings support improved reliability in stroke outcome assessment in both clinical settings and research trials.
Background:
Modified Rankin Scale and Barthel Index are the most common scales for assessing stroke outcomes in clinical practice and trials. Concordance between the Barthel Index scores and the modified Rankin Scale grades is important to define favorable outcome in clinical practice and stroke trials consistently. The purpose of this study was to examine the relationship between the scores of Barthel Index and 3-item Barthel Index Short Form with the modified Rankin Scale grades of acute stroke patients.
Methods:
Barthel Index, Barthel Index Short Form scores and modified Rankin Scale grades of 516 stroke patients were obtained from a follow-up study of the Longshi Scale in China. A study showed that the assignment of modified Rankin Scale grades to stroke patients was prone to misclassification. Therefore, the recorded modified Rankin Scale grades were compared with the Barthel Index scores of each patient to produce the adjusted modified Rankin Scale grades. Receiver operating characteristics curve analyses were performed to determine the optimal cutoff scores, respective sensitivities and specificities of Barthel Index and Barthel Index Short Form with the corresponding adjusted modified Rankin Scale grades ≤1, ≤2 and ≤3.
Findings:
About 44% of the recorded modified Rankin Scale grades of patients required adjustment. The optimal cutoff scores were ≥100 (sensitivity 100%; specificity 95.3%), ≥100 (sensitivity 98.1%; specificity 100%) and ≥75 (sensitivity 93.8%; specificity, 91.9%) for the Barthel Index and ≥40 (sensitivity 100%; specificity 78.9%), ≥40 (sensitivity 98.1%; specificity 82.8%), and ≥35 (sensitivity 99.3%; specificity, 91.6%) for the Barthel Index Short Form corresponding to the adjusted modified Rankin Scale grade ≤1, ≤2, and ≤3 respectively. The areas under the receiver operating characteristic curves were nearly all above 0.9.
Conclusions:
The optimal cutoff scores of Barthel Index and Barthel Index Short Form corresponding to the modified Rankin Scale grades ≤1, ≤2 and ≤3 were recommended to be ≥100 and ≥40, ≥100 and ≥40, and ≥75 and ≥35 respectively for determining the favorable and unfavorable outcome of stroke patients within three months of onset in clinical practice and trials.
