Is the Barthel Scale appropriate in non-industrialized countries? A view of rural Pakistan.
OBJECTIVE
To determine if the Barthel Index, a conventional scale for assessing disability, is appropriate for stroke patients in rural Pakistan, rather than an observational study by visiting stroke patients in their homes.


METHODS
Stroke patients attending hospital out patient clinics in Islamabad, together with others identified in local villages, were assessed to test the validity of the Barthel Activities of Daily Living Scale.


RESULTS
For each item on the disability scale, differences in local customs, lifestyle and architecture meant that the Barthel Scale was not appropriate in rural Pakistan.


CONCLUSIONS
There is unlikely to be a disability scale which can be applicable universally. Care must be taken when standard scales are used for international comparisons of stroke disability.
Ali
S M
SM
Department of Medicine for the Elderly, St James's University Hospital, Leeds, UK.
Mulley
G P
GP
D000203:Activities of Daily Living; D000368:Aged; D002561:Cerebrovascular Disorders / Q000534:rehabilitation*; D003906:Developing Countries; D005069:Evaluation Studies as Topic; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D015203:Reproducibility of Results; D012424:Rural Population