title: Development of a Barthel Index based on dyspnea for patients with respiratory diseases.
abstract: BACKGROUND
  As Barthel Index (BI) quantifies motor impairment but not breathlessness, the use of only this index could underestimate disability in chronic respiratory disease (CRD). To our knowledge, no study evaluates both motor and respiratory disability in CRD during activities of daily living (ADLs) simultaneously and with a unique tool. The objective of this study was to propose for patients with CRD an additional tool for dyspnea assessment during ADLs based on BI items named Barthel Index dyspnea.
  
  
  METHODS
  Comprehensibility, reliability, internal consistency, validity, responsiveness, and ability to differentiate between disease groups were assessed on 219 subjects through an observational study performed in an in-hospital rehabilitation setting.
  
  
  RESULTS
  Good comprehensibility, high reliability (interrater intraclass correlation coefficient was 0.93 [95% confidence interval 0.892-0.964] and test-retest intraclass correlation coefficient was 0.99 [95% confidence interval 0.983-0.994]), good internal consistency (Cronbach's alpha 0.89), strong concurrent validity with 6 minute walking distance (Pearson r=-0.538, P<0.001) and Medical Research Council (Spearman r S=0.70, P<0.001), good responsiveness after rehabilitation (P<0.001), and good appropriateness of the index were found evidencing patients with different dyspnea severity. Divergent validity showed weak correlation (Pearson r=-0.38) comparing Barthel Index dyspnea and BI.
  
  
  CONCLUSIONS
  The BI based on dyspnea perception proved to be reliable, sensitive, and adequate as a tool for measuring the level of dyspnea perceived in performing basic daily living activities. A unique instrument simultaneously administered may provide a global assessment of disability during ADLs incorporating both motor and respiratory aspects.
authors.affiliation: Respiratory Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Institute of Lumezzane, Brescia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.affiliation: Respiratory Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Institute of Lumezzane, Brescia, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Paneroni
authors.affiliation: Scientific Direction, Salvatore Maugeri Foundation, IRCCS, Institute of Pavia, Pavia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Baiardi
authors.affiliation: Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Cassano delle Murge, Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: De Carolis
authors.affiliation: Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Tradate, Varese, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Zampogna
authors.affiliation: Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Veruno, Novara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Belli
authors.affiliation: Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Cassano delle Murge, Bari, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carone
authors.affiliation: Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Tradate, Varese, Italy; Respiratory Diseases Unit, University of Insubria, Varese, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spanevello
authors.affiliation: Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Veruno, Novara, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Balbi
authors.affiliation: Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Institute of Tradate, Varese, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bertolotti
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D004185:Disability Evaluation; D004417:Dyspnea / Q000175:diagnosis* / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015588:Observer Variation; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D000070857:Walk Test
keywords: activities of daily living; chronic obstructive pulmonary disease; psychometric tests; pulmonary rehabilitation