Use of a 3-Item Short-Form Version of the Barthel Index for Use in Stroke: Systematic Review and External Validation.
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.



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).



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 (allP<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.



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.
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.).
Rachael L
RL
MacIsaac
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.).
Myzoon
M
Ali
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.).
Martin
M
Taylor-Rowan
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.).
Helen
H
Rodgers
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.).
Kennedy R
KR
Lees
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.). terry.quinn@glasgow.ac.uk.
Terence J
TJ
Quinn
D000203:Activities of Daily Living; D006801:Humans; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*
activities of daily living; adult; language; registries; stroke