I know the medical world thinks this is a useful tool but from a survivors perspective this is quite worthless and I don't see how using this for therapy testing of trials does any good. It can't tell if you can extend your arm better after a therapy. I would argue you need to start from a damage diagnosis using fMRI and compare that after the trial to another fRMI. By the time I got out of the hospital I was at the max score so from that perspective I shouldn't have needed any more therapy. You could really cut down on stroke rehab costs using the Barthel Index as a basis. But you wouldn't find any survivors who would agree with that.
http://stroke.ahajournals.org/cgi/content/short/STROKEAHA.110.598540v1
Abstract
Background and Purpose—Robust(nothing about this is robust - my editorial) measures of functional outcome are required to determine treatment effects in stroke trials. Of the various measures available, the Barthel index (BI) is one of the more prevalent. We aimed to describe validity, reliability, and responsiveness (clinimetric properties) of the BI in stroke trials.
Methods—Narrative review of published articles describing clinimetric properties or use of the BI as a stroke trial end point.
Results—Definitive statements on properties of BI are limited by heterogeneity in methodology of assessment and in the content of "BI" scales. Accepting these caveats, evidence suggests that BI is a valid measure of activities of daily living; sensitivity to change is limited at extremes of disability (floor and ceiling effects), and reliability of standard BI assessment is acceptable. However, these data may not be applicable to contemporary multicenter stroke trials.
Conclusions—Substantial literature describing BI clinimetrics in stroke is available; however, questions remain regarding certain properties. The "BI" label is used for a number of instruments and we urge greater consistency in methods, content, and scoring. A 10-item scale, scoring 0 to 100 with 5-point increments, has been used in several multicenter stroke trials and it seems reasonable that this should become the uniform stroke trial BI.
The 4 point scoring system developed in 1988 by Barthal has poor sensitity to change. Improving from needing major help to needing minor help doesn't do a good job of differentiating among clients. The Barthal Index focuses only on self-care. This leaves the advanced ADLs skills that stroke survivors who return to the community. The key word in the Results section is "comtemporary."
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