ADL status in stroke: relative merits of three standard indexes

Independence in activities of daily living (ADL) in 148 Framingham Study stroke survivors was scored using 3 standard indexes--the Katz Index of ADL, the Barthel Index, and the Kenny Self-Care Evaluation. Complete independence was designated in 35.1% by the Barthel Index, 39.2% by the Katz Index of ADL, and 41.9% by the Kenny Self-Care Evaluation. These differences in frequency are not statistically significant. There is also a high degree of agreement between the scores derived by the 3 indexes as measured by the Kappa Coefficient of Agreement ands the Spearman Rang-Order Correlation Coefficient. In general, each index adequately classifies stroke survivors as dependent or independent. Of the 3, the Barthel Index appears to possess certain advantages which include completeness, sensitivity to change, amenability to statistical manipulation, and greater familiarity due to more widespread use.