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Test-retest and inter-method reliability of the self-rating Barthel Index
K Hachisuka1, H Ogata, H Ohkuma
1Department of Rehabilitation Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan.
Insights
This study developed a self-rating Barthel Index (SB) for stroke patients. Version 3 demonstrated sufficient reliability for practical use in assessing home-dwelling stroke survivors.
Area of Science:
- Rehabilitation Medicine
- Neuroscience
- Gerontology
Background:
- Accurate assessment of functional status is crucial for stroke patient rehabilitation.
- Existing tools may require adaptation for self-administration by home-dwelling stroke patients.
- The Barthel Index (BI) is a widely used functional assessment tool.
Purpose of the Study:
- To develop a self-rating version of the Barthel Index (SB) for home-dwelling stroke patients.
- To evaluate the test-retest reliability of SB versions 1 and 2.
- To assess the inter-method reliability of SB version 3 against occupational therapist (OT) and family ratings.
Main Methods:
- A case series design was employed across university hospital rehabilitation clinics.
- Chronic stroke patients without severe aphasia were recruited for SB versions 1 (n=31), 2 (n=140), and 3 (n=65).
- Reliability was assessed using kappa coefficients for item agreement and intra-class correlation coefficients for overall scores.
Main Results:
- SB version 2 showed higher test-retest reliability (kappa coefficients) than version 1.
- SB version 3 demonstrated good inter-method reliability (intra-class correlation coefficients) among self, family, and OT ratings.
- Most items in SB version 3 showed good to excellent agreement, with no significant ranking differences except for stair negotiation.
Conclusions:
- The self-rating Barthel Index (SB) version 3 is a reliable tool for assessing functional status in home-dwelling stroke patients.
- SB version 3 is suitable for practical clinical application in stroke rehabilitation.
- Further analysis indicated that OT ratings and time to complete the questionnaire influenced score discrepancies.
Objective:
To develop a self-rating Barthel Index questionnaire (SB) for assessing stroke patients living at home, the test-retest reliability of SB versions 1 and 2 and the inter-method reliability of SB version 3 were examined.
Design:
Case series.
Setting:
Clinics of the Department of Rehabilitation Medicine at the University Hospital and two affiliated hospitals.
Patients:
Thirty-one, 140 and 65 chronic stroke patients living at home, being seen for regular follow-up, and having no severe aphasia for SB versions 1, 2 and 3, respectively.
Main Outcome Measure:
Kappa coefficients of items in SB versions 1 and 2 for test-retest reliability, intra-class correlation coefficients of the self-care index, mobility index and total score, kappa coefficients of items and Friedman's two-way ANOVAs of ranking in SB version 3 among the self-ratings, family ratings and occupational therapist (OT) ratings; a regression analysis of age, gender, duration, time for filling in the SB, OT ratings, Mini-Mental State score and aphasia.
Results:
Kappa coefficients in SB version 2 were higher than those in version 1. Intra-class correlation coefficients in SB version 3 among the three ratings were good, and kappa coefficients in each item were also good or excellent. By Friedman's two-way ANOVA, all the items except walking up/down stairs had no significant difference in ranking. Regression analysis revealed that OT ratings and time for filling in the SB affected the absolute difference of scores between the self-ratings and OT ratings.
Conclusions:
SB version 3 is sufficiently reliable for practical use.