Use of a 3-item short-form version of the Barthel Index for use in stroke

MacIsaac, R. L., Ali, M. , Taylor-Rowan, M. , Rodgers, H., Lees, K. R. and Quinn, T. J. (2017) Use of a 3-item short-form version of the Barthel Index for use in stroke. Stroke, 48(3), pp. 618-623. (doi: 10.1161/STROKEAHA.116.014789) (PMID:28154094)

Abstract

Background and Purpose—There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. Methods—We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). Results—From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P<0.001). Using rehabilitation trial data (n=332), SF-BI demonstrated modest correlation with quality of life measures Stroke Impact Scale and 5 domain EuroQOL (ρ≥0.50, P<0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P<0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. Conclusions—There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Macisaac, Dr Rachael and Lees, Professor Kennedy and Ali, Dr Myzoon and Quinn, Professor Terry and Taylor-Rowan, Dr Martin
• Authors: MacIsaac, R. L., Ali, M., Taylor-Rowan, M., Rodgers, H., Lees, K. R., and Quinn, T. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Published Online: 02 February 2017
• Copyright Holders: Copyright © 2017 American Heart Association
• First Published: First published in Stroke 48(3):618-623
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher