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The Barthel ADL index: scoring by the physician from patient interview is not reliable
1County Hospital of Kristiansund N, Norway.
Insights
Physician assessments of elderly patients' daily living activities using the Barthel index differed from nurse observations. Agreement was poor overall, but fair for mobility tasks in patients with higher cognitive function.
Area of Science:
- Gerontology
- Rehabilitation Medicine
- Clinical Assessment
Background:
- Accurate assessment of Activities of Daily Living (ADL) is crucial for elderly care.
- The Barthel index is a common tool for measuring ADL performance.
- Discrepancies in ADL scoring can impact patient care and resource allocation.
Purpose of the Study:
- To compare physician-based ADL scoring with nurse-based observational scoring in nursing home residents.
- To evaluate the agreement between physician and nurse ADL assessments using the Barthel index.
- To identify factors influencing agreement in ADL scoring.
Main Methods:
- A study involving 59 elderly nursing-home patients.
- Physician ADL scoring via clinical interviews using the Barthel index.
- Nurse ADL scoring based on longitudinal observations (reference method).
- Statistical analysis using kappa statistics to assess inter-rater agreement.
Main Results:
- Physician ADL scores were significantly higher than nurse scores (mean 14.3 vs. 12.2).
- Overall agreement between physician and nurse scoring on the Barthel index items was poor.
- Fair to good agreement was observed for mobility-related items in patients with higher Mini-Mental Status scores.
Conclusions:
- Physician clinical interviews may overestimate ADL performance compared to nurse observations.
- Cognitive status influences the accuracy of physician ADL assessments, particularly for mobility.
- Recommendations for improving ADL assessment consistency in geriatric care settings.
Abstract:
Using the Barthel index, a physician's ADL scoring based upon clinical interviews of 59 elderly nursing-home patients was compared with the scoring by nurses based upon observations over time (the reference method). The scoring by the doctor was higher than that by the nurses (mean score 14.3 vs 12.2), and 11.1). Use of the kappa statistics on each item of the Barthel ADL index showed that, in general, the agreement was poor between physician's scoring and the reference method. However, information collected by the physician on Barthel index items reflecting mobility demonstrated fair to good agreement among patients with a higher score on the Mini-Mental Status.