title: Diagnostic accuracy of the Barthel Index for measuring activities of daily living outcome after ischemic hemispheric stroke: does early poststroke timing of assessment matter?
abstract: OBJECTIVE
  This study investigated the diagnostic accuracy of the Barthel Index (BI) in 206 stroke patients, measured within 72 hours, for activities of daily living at 6 months and determined whether the timing of BI assessment during the first days affects the accuracy of predicting activities of daily living outcome at 6 months.
  
  
  METHODS
  Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cutoff points for BI at Days 2, 5, and 9. OR, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to predict BI ≥19.
  
  
  RESULTS
  The area under the curve ranged from 0.785 on Day 2 to 0.837 and 0.848 on Days 5 and 9. Comparison of the receiver operating characteristic curves showed that the area under the curve was significantly different between Days 2 and 5 (P<0.001) and between Days 2 and 9 (P<0.001). No significant difference was found between Days 5 and 9 (P=0.08). Using a BI cutoff score of 7, the positive predictive value gradually increased from 0.696 on Day 2 to 0.817 on Day 2 to 0.864 on Day 9, whereas negative predictive value declined from 0.778 on Day 2 to 0.613 on Day 9.
  
  
  CONCLUSIONS
  Assessment of the BI early poststroke showed good discriminative properties for final outcome of BI at 6 months. However, Day 5 proved to be the earliest time for making an optimal prediction of final outcome of activities of daily living. The BI should be measured at the end of the first week in hospital-based stroke units for early rehabilitation management.
authors.affiliation: Department of General Practice, University of Groningen, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
authors.forename: Janne M
authors.initials: JM
authors.lastname: Veerbeek
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Harmeling-van der Wel
authors.forename: Erwin
authors.initials: E
authors.lastname: van Wegen
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome