The Barthel ADL index one year after stroke: comparison between relatives' and occupational therapist's scores

The activities of daily living of 54 patients 1 year after stroke were rated with the Barthel Index by an occupational therapist (OT). A physician independently rated the same patients from interviews with their nearest relative. The mean sum-score obtained by the doctor was 16.7, while the mean sum-score obtained by the OT was 17.1. In more than 80% of the patients, the difference in sum-score was two points or less, which was considered to reflect acceptable agreement. Weighted kappa values of each item varied between 0.42 and 0.92, indicating moderate agreement for the items 'grooming' and 'bladder' and good or very good agreement for the other items. There was a statistically significant bias in the bladder item; the doctor's score being lower than that of the OT. The other items showed no significant bias. The probability of disagreement between the two raters increased with the patient's age; no other factors were found to be related to disagreement.