Use of a 3-Item Short-Form Version of the Barthel Index for Use in Stroke

This research is pretty useless with the Barthel scales also being subjective. Isn't anyone ever going to start using objective 3d scans of damage and location to determine stroke severity and recovery possibilities?
http://stroke.ahajournals.org/content/48/3/618?etoc=

Rachael L. MacIsaac, Myzoon Ali, Martin Taylor-Rowan, Helen Rodgers, Kennedy R. Lees, Terence J. Quinn

and on behalf of the VISTA Collaborators

https://doi.org/10.1161/STROKEAHA.116.014789

Stroke. 2017;48:618-623

Originally published February 2, 2017

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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.