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The Barthel ADL index: factor structure depends upon the category of patient
K Laake1, P Laake, A H Ranhoff
1Department of Geriatric Medicine, Ullevål Hospital, Oslo, Norway.
Insights
The Barthel index is unidimensional for stroke patients but not for geriatric or hip fracture patients. A single sum-score may oversimplify the complex structure for these groups.
Area of Science:
- Geriatric Medicine
- Neurology
- Orthopedics
Background:
- The Barthel index is a common tool for assessing functional status in patients.
- Its psychometric properties require validation across diverse patient populations.
Purpose of the Study:
- To evaluate the validity and reliability of the Barthel index.
- To assess its dimensionality in geriatric, stroke, and hip fracture patient cohorts.
Main Methods:
- Factor analysis was employed, accounting for the ordinal nature of Barthel index items.
- The study included 60 geriatric patients, 87 stroke patients, and 102 hip fracture patients.
Main Results:
- The Barthel index demonstrated unidimensionality in stroke patients.
- In geriatric and hip fracture patients, two factors emerged: mobility and bodily functions.
- A single sum-score may not adequately represent the functional status in these latter groups.
Conclusions:
- The Barthel index's structure varies across patient populations.
- Unidimensionality is confirmed for stroke patients, but not for geriatric or hip fracture patients.
- Careful consideration of the index's complex structure is needed for geriatric and hip fracture patient assessment.
Abstract:
The validity and reliability of the Barthel index were studied in 60 geriatric patients, 87 stroke patients, and 102 patients with hip fracture, using a factor analysis methodology which explicitly accounts for the ordinal nature of the scoring on each item. The findings substantiate that the Barthel index is unidimensional among stroke patients, but not among geriatric patients or patients with hip fracture. In the latter two groups, one factor related to mobility, the other to bodily functions. A sum-score to characterize geriatric and hip fracture patients does not take into account the complex structure of the Barthel index.