Barthel Index-Based Activity Evaluation at Admission Predicts Wound Prognosis in Chronic Limb-Threatening Ischemia

The Barthel Index (BI) is a reliable tool for assessing the level of independence in activities of daily living (ADLs). Current risk stratification for chronic limb-threatening ischemia (CLTI) primarily focuses on anatomical severity and comorbidities, with less emphasis on functional status. Although several studies have examined its prognostic utility in patients with CLTI, the association between BI at admission and wound healing outcomes remains unclear, particularly in the context of multidisciplinary treatment strategies.

This retrospective single-center study included 187 patients (220 limbs) with CLTI and tissue loss who underwent endovascular treatment (EVT). Patients were stratified into 4 groups according to their BI at admission: total independence (TI, BI ≥ 85), partial independence (PI, BI: 61-84), partial assistance (PA, BI: 41-60), and total assistance (TA, BI: ≤ 40). The primary endpoint was wound healing rate, and secondary analyses examined major amputation and ADL recovery.

Baseline disease severity and treatment characteristics were comparable among the 4 groups. Most patients showed functional improvement during hospitalization, except those with high baseline BI who already maintained good independence. However, patients in the TA group exhibited significantly lower 1-year wound healing rates compared with PA, PI, and TI groups. Major amputations were also more frequent in the TA group. Multivariable Cox regression analysis identified BI ≤ 40 at admission as an independent negative predictor of wound healing, suggesting limited responsiveness to standardized multidisciplinary care, including EVT and rehabilitation, in these patients.

A lower BI at admission was associated with delayed wound healing and a higher risk of major amputation despite appropriate EVT. These findings highlight the clinical value of incorporating functional assessment into current risk stratification frameworks. Barthel Index assessment at admission is a simple and reliable prognostic indicator for patients with CLTI and may aid in early risk stratification and optimization of treatment strategies, including the consideration of the intensity of revascularization and rehabilitation efforts.Clinical ImpactThis study demonstrates that the Barthel Index, a simple and readily available measure of functional status, provides clinically meaningful prognostic information in patients with chronic limb-threatening ischemia beyond conventional assessments of disease severity. A low Barthel Index at admission identifies patients who remain at high risk for delayed wound healing and major amputation despite guideline-based multidisciplinary treatment, including endovascular revascularization. Incorporating the Barthel Index into the initial evaluation improves risk stratification, facilitates individualized treatment planning, optimizes rehabilitation and resource allocation, and supports shared decision-making.