Barthel Index (BI)

Purpose

The Barthel Index (BI) measures the extent to which somebody can function independently and has mobility in their activities of daily living (ADL)Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis. i.e. feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. The index also indicates the need for assistance in care. The BI is a widely used measure of functional disability. The index was developed for use in rehabilitation patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and other neuromuscular or musculoskeletal disorders, but may also be used for oncology patients.

In-Depth Review

Purpose of the measure

The Barthel Index (BI) measures the extent to which somebody can function independently and has mobility in their activities of daily living (ADL)Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis. i.e. feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. The index also indicates the need for assistance in care.

The BI is a widely used measure of functional disability. The index was developed for use in rehabilitation patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and other neuromuscular or musculoskeletal disorders, but may also be used for oncology patients.

Available versions

The BI was first developed by Mahoney and Barthel in 1965 and later modified by Collin, Wade, Davies, and Horne in 1988.

• Original 10-item version (Mahoney & Barthel, 1965). Refers to the following 10 categories: feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. Items are weighted according to the level of nursing care required and are rated in terms of whether individuals can perform activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
  independently, with some assistance, or are dependent (scored as 10, 5 or 0).

Features of the measure

Items:

The original 10-item form of the BI consists of 10 common ADL activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
including: feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. Items are rated in terms of whether individuals can perform activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
independently, with some assistance, or are dependent (scored as 10, 5 or 0). Items are weighted according to the level of nursing care required.

Scoring:

The score of the BI is a summed aggregate and there is preferential weighting on mobility and continence. The scores are allotted in the following way: 0 or 5 points per item for bathing and grooming; 0, 5, or 10 points per item for feeding, dressing, bowel control, bladder control, toilet use, and stairs; 0, 5, 10, or 15 points per item for transfers and mobility. The Index yields a total score out of 100 – the higher the score, the greater the degree of functional independence (McDowell & Newell, 1996). This score is calculated by simply totaling the individual item scores, which requires simple arithmetic computation
by hand.

A modified scoring system has been suggested by Shah, Vanclay, & Cooper (1989) using a 5-level ordinal scale for each item to improve sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
to detecting change (1=unable to perform task, 2=attempts task but unsafe, 3=moderate help required, 4=minimal help required, 5=fully independent). Shah and coll. (1989) note that a score of 0-20 suggests total dependence, 21-60 severe dependence, 61-90 moderate dependence and 91-99 slight dependence.

Subscales:

None typically reported.

Equipment:

To administer the BI, one only needs a pencil and the test items.

Training:

Administration of the BI does not require training and has been shown to be equally reliable when administered by skilled and unskilled individuals (Collin & Wade, 1988). The BI can also be self-administered (McGinnis, Seward, DeJong, & Osberg, 1986). However, for patients older than 75 years of age, it is not recommended that the BI be administered as a self-report measure (Sinoff & Ore, 1997). One study suggests that the scale can be administered reliably over the telephone (Korner-Bitensky & Wood-Dauphinee, 1995).

Time:

The BI can take as little as 2-5 minutes to complete by self-report and up to 20 minutes to complete by direct observation (Finch, Brooks, Stratford, & Mayo, 2002).

Alternative forms of the BI

• Modified 10-item version (MBI)(Collin et coll., 1988). Functional categories may be scored from 0 to 1, 0 to 2, or 0 to 3, depending on the item. Total scores range from 0 to 20.
• 5-item short form(Hobart & Thompson, 2001). The 5-item version refers to the following 5 categories: transfers, bathing, toilet use, stairs, and mobility. Each item is scored 0 to 1, 0 to 2, or 0 to 3, depending on the function. Total scores range from 0 to 20. Hobart & Thompson (2001) found that the 5-item BI is psychometrically equivalent to the 10-item BI (correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
  with original version was r = 0.90).
• The expanded 15-item version(Granger et coll., 1979; Fortinsky & Granger, 1981). Added a 4-point scale of intact/limited/helper required/null. Scores range from 0 to 100. In the 15-item version, a score of 60 is commonly considered to be the threshold score for marked dependence (Granger, Sherwood, & Greer, 1977). High correlations of the expanded 15-item BI and other measures of function have been demonstrated (e.g., with Katz Indice of ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
  of Daily Living, r = 0.78; with PULSES profile (medical status, upper and lower limb function, sensory and excretory function, mental and emotional status), r = -0.74 to -0.90 (Shinar, Gross, Bronstein, Licara-Gehr, Eden, Cabrera, et coll., 1987; Granger, 1985; Rockwood, Stolee & Fox, 1993). Scores were also predictive of return to independent living after 6 months (Granger, Hamilton, Gresham, & Kramer, 1989).
• The extended BI (EBI)(Prosiegel, Bottger, & Schenk, 1996). The EBI consists of 16 items, 15 of which are identical to the Functional Independence Measure. Very little literature exists on the EBI, however Jansa, Pogacnik, and Gompertz (2004) found it to be a reliable and valid measure of disability/activity levels in 33 patients with newly diagnosed acute ischemic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• The 3-item BI(Ellul, Watkins, & Barer, 1988).Based on 3 items (bed-chair transfers, mobility, and bladder incontinence), it is a useful alternative to the full BI for assessing function at hospital discharge. To date, this version has only been validated in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• Self-rating BI(SB). The SB has good concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
  and is well related with the original BI and the Functional Independence Measure. The indexes test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
  is sufficiently high for practical use (Hachisuka, Ogata, Ohkuma, Tanaka, & Dozono, 1997; Hachisuka, Okazaki, & Ogata, 1997; McGinnis et coll., 1986).
• Early Rehabilitation Barthel Indice (ERI). An extension of the BI, it was developed to assess functioning of individuals with severe brain damage, who often cannot be differentiated appropriately due to floor effects that occur with increasing severity of neurological impairment. The ERI looks at the following aspects: state requiring temporary intensive medical monitoring“The process of checking the task over time for ‘quality control’ and the adjustment of behavior” (Stuss, 2009, p. 9-10)
  , tracheostoma requiring special treatment (suctioning), intermittent artificial respiration, confusional state requiring special care, behavioural disturbances requiring special care, swallowing disorders requiring special care, and severe communication deficits. Schonle (1995) found that the ERI is quick, economical, and reliable when administered to 210 early rehabilitation patients and 312 patients with severe brain damage.

There is little consensus over which should be considered the definitive version of the BI (McDowell & Newell, 1996), but the original and the 10-item and 15-item modifications are the most commonly used.

Client suitability

Can be used with:

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The BI is a frequently used strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. outcome measure. It has been repeatedly shown to be a reliable and valid measure of basic ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living (Mahoney & Barthel, 1965; Loewen & Anderson, 1990; Gresham, Phillips & Labi, 1980; Collin et coll., 1988; Roy, Tongeri, Hay, & Pentland, 1988; Wade & Hewer, 1987; Leung et coll., 2007). In patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., the BI determines the extent of post-stroke disability, self-care activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and ability to live independently. The total score of the BI has also been found to predict length of stay in hospital (Granger, Albrecht, & Hamilton, 1979).

There are no prerequisites for completing the BI. For patients who are unable to respond to the BI independently, the BI can be completed by proxy (eg. Duncan, Lai, Tyler, Perera, Reker, & Studenski, 2002; Wyller, Sveen, & Bautz-Holter 1995). Further, the BI can be reliably administered over the telephone to either the patient or their proxy (Korner-Bitensky & Wood-Dauphinee, 1995).

Should not be used in:

• To capture significant losses in higher levels of physical function or activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
  that are necessary for independence in the home and community. This means that patients can still score a maximum score of 100 and experience significant impairments (Kelly-Hayes et al., 1998).
• It should be used with caution in patients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. It is responsive to change but has definite ceiling effects in persons with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (Wade & Hewer, 1987; Skilbeck, Wade, Hewer, & Wood, 1983).

In what languages is the measure available?

The BI has been translated and validated in:

• Dutch (Post, van Asbeck, van Dijk, & Schrijvers, 1995)
• German (Heuschmann et al., 2005; Valach, Signer, Hartmeier, Hofer, & Steck, 2003)
• Turkish (Kucukdeveci, Yavuzer, Tennant, Suldur, Sonel, & Arasil, 2000)
• Persian (Oveisgharan, 2006)
• French (Condouret et al., 1988; Wirotius & Foucher-Berres, 1991)
• Chinese (Leung, Cha, & Shah, 2007) (modified Barthel Index)

Summary

What does the tool measure?	ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of Daily Living
What types of clients can the tool be used for?	Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., patients with other neuromuscular or musculoskeletal disorders, oncology patients
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment
Time to administer	Self report: 2-5 minutes; Direct observation: 20 minutes, but may vary according to patient’s abilities and tolerance
Versions	Modified 10-item version (MBI); 5-item short form; The expanded 15-item version; The extended BI (EBI); The 3-item BI; Self-rating BI (SB); Early Rehabilitation Barthel Index (ERI)
Other Languages	Dutch, German, Turkish, Persian, French, Chinese
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: Five studies of the MBI reported excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.. Test-retest: One study of the MBI reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). . Inter-rater: One study of the MBI and four studies of BI reported excellent inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. ; and one study of the BI reported adequate inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. .
ValidityThe degree to which an assessment measures what it is supposed to measure.	Criterion: Concurrent: One study demonstrated excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” between the MBI and motor-Functional Independence Measure (FIM) at admission and discharge. Predictive: The MBI predicted instrumental ADL permformance at 6-months post-stroke; likelihood a patient will regain continence following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.; risk for falls in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.; functional recovery following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.; and acute care hospital length following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Construct: Excellent correlations in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. on the physical mobility dimension of the Nottingham Health Profile SubscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). ; the Physical Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). of the SF-36; Berg Balance Scale; the Fugl-Meyer Assessment Scale; Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. Indice.
Does the tool detect change in patients?	Significant ceiling effects noted for the BI, meaning that it doesn’t detect change well in highly functional individuals. The Functional Independence Measure was developed as a measure that would be better able to detect change in disability than the BI, however little to no difference has been found. Out of 8 studies examined, 3 reported that the BI had a large ability to detect change, 3 reported adequate ; 2 reported small.
Acceptability	The MBI/BI has been evaluated for both self-report and use with proxy respondents in addition to direct observation.
Feasibility	The MBI/BI is simple to administer. Requires training if administered by direct observation. It has been developed in many forms that can be administered in many situations and can be used for longitudinal assessment.
How to obtain the tool?	For a copy of the original BI click here.

Psychometric Properties

Overview

There is considerable psychometric data available for the BI (McDowell & Newell, 1996) and its various modified versions. For the purposes of this review, we conducted a literature search to identify all relevant publications on the psychometric properties of the original BI and the modified 10-item BI (MBI), the two most commonly used versions. We then selected to review articles from high impact journals, and from a variety of authors.

*Please note that the content in the original BI and MBI version of the BI is the same. Only the scoring values were changed in the MBI version (scored 0, 1, 2 or 3 versus 0, 5 and 10 in the original version), and thus do not impact the clinimetric properties of the tool (Quinn, Langhorne and Stott, 2011). The MBI yields a score ranging from 0 to 20, whereas the original BI yields a score of 0 to 100. For the purposes of this module, the psychometric properties for both the BI and MBI will be presented together and will be referred to as either the BI or MBI.

Floor and ceiling effect

Salbach et coll. (2001) examined the ceiling effects of the BI, Timed Up and Go (TUG), Berg Balance Scale (BBS), 10 meter walk test (10mWT) and 5 meter walk test (5mWT) in 50 patients with residual gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
deficits after a first-time strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The BI demonstrated the most significant ceiling effects at both 8 and 38 days post-stroke (28% and 56% respectively).

Dromerick, Edwards and Diringer (2003) examined the floor/ceiling effects of the BI, the Functional Independence Measure (FIM), the Modified Rankin Scale (MRS) and the International StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Trial Measure. The four measures were administered to 95 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. on admission to and discharge from rehabilitation. The BI demonstrated adequate floor effects at admission (5%) and poor ceiling effects at discharge (27%), whereas the FIM demonstrated excellent floor and ceiling effects (0% for both); the MRS demonstrated adequate floor effects at admission (18%) and excellent ceiling effects at discharge (0%); and the International StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Trial Measure demonstrated poor floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also "ceiling effect."
at admission (100%) and excellent ceiling effectA ceiling effect occurs when test items aren't challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes - the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also "floor effect." at discharge (0%).

Van der Putten, Hobart, Freeman and Thompson (1999) compared the floor/ceiling effects of the MBI to that of the Motor-FIM, cognitive-FIM and total FIM in 201 patients with multiple sclerosis and 82 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. undergoing inpatient neurorehabilitation. The MBI, and motor-FIM demonstrated adequate floor and ceiling effects for both patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and patients with multiple sclerosis (floor effects = 1.2% (BI, strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.), 1.2% (motor-FIM, strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.); and ceiling effects = 8.5% (BI, strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.) and 1.2% (motor-FIM, strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.). The total-FIM showed no floor or ceiling effects for both patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and patients with MS (0% for all). The Cognitive-FIM demonstrated poor ceiling effects in patients with multiple sclerosis (36%) and adequate ceiling effects in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Hsueh, Lin, Jeng and Hsieh (2002) compared the floor/ceiling effects of the FIM to that of the MBI and the 5-item BI (BI-5) in 118 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. undergoing treatment on an inpatient rehabilitation unit. The MBI and the motor-FIM both exhibited adequate floor effects at admission and discharge (MBI 18.2% and 4.7%; motor-FIM 5.8% and 3.5% respectively) and excellent ceiling effects at admission and discharge (0% for all). The BI-5 exhibited poor floor effects at admission (46.6%) and adequate floor effects at discharge (13.6%), and excellent ceiling effects at admission and discharge. The results of this study indicate that the MBI and motor-FIM have comparable floor/ceiling effects, with the motor-FIM performing slightly better with respect to floor effects (18.2% vs. 5.8%).

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
Hobart and Thompson (2001) compared the psychometrics of the MBI, FIM and the 30-item FIM + Functional Assessment Measure (FIM+FAM) in 149 patients with various neurological disorders. All measures were found to be psychometrically similar measures of physical disability. The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the MBI was excellent, with a Cronbach’s alpha of 0.94 (Cronbach’s alpha of the FIM ranged from 0.89-0.96).

Hsueh, Lin, Jeng and Hsieh (2002) compared the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the FIM to that of the MBI and the 5-item BI (BI-5) in 118 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. undergoing treatment on an inpatient rehabilitation unit. The MBI and FIM motor subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
both demonstrated excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. (Cronbach’s alpha coefficient ≥ 0.84), whereas the BI-5 demonstrated adequate internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. (Cronbach’s alpha coefficient ≥ 0.71) at admission and discharge.

Quinn, Langhorne and Stott (2011) conducted a literature review examining the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the MBI in studies involving patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the MBI was found to be excellent (Cronbach’s alpha ³ 0.80) across all reviewed studies, as detailed below.

Shah and coll. (1989) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the MBI in 258 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. was excellent (Cronbach’s alpha 0.90).

Leung and coll. (2007) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the Chinese version and the English version of the MBI and found internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. to be excellent for both measures (Cronbach’s alpha 0.93 and 0.92 respectively).

Hseuh, Lee and Hsieh (2001) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the MBI in 121 Taiwanese patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. at four time points (14, 30, 90 and 180 days post-stroke). The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the BI was excellent (Cronbach’s alpha 0.89-0.92).

Test-retest:
Green, Forster and Young (2001) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the MBI, Rivermead Mobility Indice (RMI), Nottingham extended ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living Scale (NEADL) and Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Indice (FAI) in 22 patients that were at least one year post-stroke. The four measures were administered twice, with a one-week interval. The MBI and RMI were found to have the strongest test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
with 75% and 85% agreement overall, respectively; however there was still considerable variability in kappa statistics (BI kappa =-0.09-0.81; RMI kappa =0.64-1.00). The NEADL and FAI demonstrated greater variability and more error (NEADL kappa =0.14-0.89; FAI kappa =0.25-1.00).

Inter-rater:
Leung and coll. (2007) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the Chinese and English versions of the MBI in 15 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was found to be excellent for the Chinese version (kappa = 0.81-1.00) and adequate to excellent for the English version (kappa =0.63-0.85), as calculated using kappa statistics.

Duffy, Gajree, Langhorne, Stott and Quinn (2013) conducted a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
examining the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the BI and MBI in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. In a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
and meta-analysisMethod in which the results of two or more studies are statistically combined. Typically used when studies have few subjects, but similar designs. By increasing the available number of subjects, more weight can be given to the findings.
, 10 studies were included that involved assessors of differing backgrounds and experience. The BI was found to have excellent inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
in eight of the ten studies and adequate inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
in two of the ten studies, as calculated using intraclass correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(ICC), kappa statistics or weighted kappa statistics (ICC ranging from 0.94 to 0.96; kappa ranging from 0.62 to 0.90; weighted kappa ranging from 0.70 to 0.99). The results from five of the 10 studies are included below; the remaining 5 studies could not be reviewed for the purposes of this module as they were not available in English.

Loewen and Anderson (1988) examined the inter-rater and intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
of the BI in seven patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
and intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
were excellent (ICC=0.96 and 0.99 respectively).

Wolfe, Taub, Woodrow and Burney (1991) compared the inter-rater and intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
of the BI with the Rankin Scale. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was excellent for both the BI and Rankin Scale (kw=0.88 to 0.98 and 0.75 to 0.95 respectively). Intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
was excellent for both the BI and Rankin Scale (kw=0.98 and 0.95 respectively).

Hseuh, Lee and Hsieh (2001) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the BI in Taiwanese patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., at four time points (14, 30, 90 and 180 days post-stroke). The inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
between items of the BI was adequate (weighted kappa = 0.53) to excellent (weighted kappa =0.94). The inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
for the total score was excellent (ICC=0.94).

Oveisgharan and coll. (2006) examined inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of a Persian translated version of the BI; inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was excellent (weighted kappa =0.99).

Cincura and coll. (2008) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the National Institutes of Health StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Scale, Modified Rankin Scale and the BI in Brazilian patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
was found to be adequate (kappa =0.70).

Validity

Content:

No studies have examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the BI in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Criterion:

Concurrent:
Hsueh, Lin, Jeng and Hsieh (2002) examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of MBI and the 5-item BI (BI-5) with the motor subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the FIM in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., using Spearman correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient. The three measures were administered to 118 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. at admission to and discharge from an inpatient rehabilitation unit. Concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the MBI and the FIM motor subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
was excellent at admission and discharge (r=0.92 and 0.94 respectively), whereas the 5-item BI demonstrated adequate to excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
with the FIM motor subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
at admission and discharge (r=0.74 and 0.92 respectively).

Predictive:
Hseuh, Lee and Hsieh (2001) examined the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the MBI in 121 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. by comparison with the Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Indice (FAI), using Pearson product-moment correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient. The MBI was administered at 14, 30, 90 and 180 days post-stroke and the FAI was administered at 180 days post-stroke. The MBI scores at 14, 30 and 90 days post-stroke demonstrated adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with FAI scores at 180 days post-stroke, (r=0.59, 0.66. 0.63 respectively). Results of this study found the MBI to be an adequate predictor of instrumental ADL performance at six months following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. onset.

Patel, Coshall, Lawrence, Rudd and Wolfe (2001) examined the ability of the MBI and Frenchay Activity Indice (FAI) to predict whether a patient with post-stroke urinary incontinence would regain continence. The study involved 207 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. with new onset urinary incontinence in the acute phase of recovery. Univariate analysis and multiple regression analysis were used to determine predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
. The MBI and the FAI were administered on approximately day seven post-stroke to allow for medical stabilization and at 3-months post-stroke. Patients scoring 15 to 18 (out of 20) on the MBI on day seven were found more likely to regain continence as compared with those scoring less than 15 (Odds ratio=21.8, 95% CI=5.95 – 79.7). At 3 months, patients with incontinence were found to have greater disability as measured by the MBI (P<0.001) and FAI (P=0.002) and greater rates of institutionalization (P<0.001).

Sze, Wong, Leung and Woo (2001) investigated the predictors of falls in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., using a study sample of 677 patients admitted to an inpatient rehabilitation stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.). Initial assessments, including the MBI, were completed on admission (three to seven days following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. onset). For the purposes of their study, MBI scores were stratified as: ≥15 mild disability, 6-14 moderate to severe disability, and ≤5 very severe disability. Patients with moderate to severe disability (MBI scores 6-14) were found to have an increase risk for falls (odds ration 2.59, 95%CI=1.24-5.42, r=0.0114). DysphagiaDifficulty, discomfort or pain in swallowing due to problems in nerve or muscle control. It is common in patients who have had a stroke. Dysphagia ranges from slight discomfort to complete inability to swallow. Dysphagia may compromise nutrition and hydration and may lead to aspiration pneumonia and dehydration.
was also found to put patients at an increased risk for falls (odds ratio 1.81; 95% CI, 1.03–3.17, r=.0382).

Tilling and coll. (2001) examined the ability of the MBI to predict functional recovery following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The MBI was administered to 299 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. at baseline, 2, 4, 6, and 12 months following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.; recovery trajectories were then plotted using the MBI scores in an effort to establish a prediction model based on the found normal patterns of recovery. Performance of the prediction model was validated using an additional group of 710 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Initial MBI scores, when considered along with individual patient characteristics (such as age, sex and pre-stroke disability), were found to be predictive of future MBI scores up to 1-year following stroke. The predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
was found to be even stronger when the patient’s actual observed recovery was taken into consideration and the predictions of future MBI scores were adjusted accordingly. Scoring <1 point below the predicted score on the MBI was found to be predictive of death before the next assessment time point (65% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
, 79% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
). The results of this study suggest that this model can aid in establishing initial recovery predictions, developing rehabilitation goals and monitoring"The process of checking the task over time for ‘quality control’ and the adjustment of behavior" (Stuss, 2009, p. 9-10)
recovery in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Chang, Tseng, Weng, Lin, Liou and Tan (2002) examined the predictors of acute care hospital length of stay in 330 patients with first-ever acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Univariate analysis and multiple regression analysis were used to determine predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
. MBI scores at admission (r=0.042), along with National Institute of Health StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Scale (NIHSS) scores at admission (r=0.001), the quadratic term of initial NIHSS score (r=0.001), small-vessel occlusion strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. (r<0.001), gender (male) (r=0.004) and smoking (r=0.043) were found to be the most significant predictors of hospital length of stay. A one-point decrease in score on the MBI (indicating a decline in function) corresponded to an increase in length of stay by approximately one day.

Hsieh and coll. (2007) investigated the minimal clinically important difference (MCID) of the modified 10-item BI in a two-part study involving patients with sub-acute to chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. In the initial part of the study, 43 patients with sub-acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. that demonstrated potential for improvement with regard to activities of daily living (ADL)Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis. were selected for a 4-week intensive occupational therapy program. The MBI and a 15-point Likert-type scale assessing the patients’ perceived global ratings of their ADL function were administered at baseline and at discharge (with a mean interval between assessment and discharge of 25 days). The estimated MCID was 1.85. The second part of the study involved assessing the repeatability of scores in 56 patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. who were thought to have stable ADL function. The estimated MCID was 1.45. Results indicate that an improvement in total score by 1.85 points or more (on the 0 to 20 scoring scale) indicate a meaningful change beyond measurement error, and thus a change in score less than 1.85 points may be subject to measurement error.
Note: The MCID estimated in this study is applicable only for improvement in function, not deterioration.

Construct:

Wilkinson and coll. (1997) investigated the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the MBI as a standard long-term outcome measure of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale (HADS), London Handicap Scale (LHS), Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Indice (FAI), SF36, Nottingham Health Profile (NHP) and the Life Satisfaction Indice (LSI) were administered alongside the MBI in a long-term study involving 106 patients with first-ever strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (patients were followed for a mean interval of 4.9 years). Rank CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients were excellent between the MBI and SF36 Physical Functioning dimension (r=0.81), NHP Energy (r=0.605) and Physical Mobility (r=0.840) dimensions, LHS (r=0.726) and FAI (r=0.826). Rank CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients were adequate between the MBI and the SF36 Social Functioning (r=0.481), Role: Physical (r=0.415), Mental Health (r=0.332), Vitality (r=0.500), Bodily Pain (r=0.356) and General Health (r=0.438) dimensions, HADS (r=-0.563), and LSI (r=0.361). Poor correlations were found between the MBI and the SF36 Role: Emotional dimension (r=0.217) and NHP Sleep dimension (r=0.189). The results of this study suggest that the MBI should be administered alongside other measures that assess the psychosocial dimensions of health status as the MBI fails to sufficiently assess these aspects.

Convergent/Discriminant:
Hseuh, Lee and Hsieh (2001) examined the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the MBI, Berg Balance Scale (BBS) and the Fugl-Meyer Motor Assessment (FMA) in 121 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., using Pearson product-moment correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient . The three measures were administered at 14, 30, 90 and 180 post-stroke. The total MBI score had excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the FMA and BBS scores at all four time points (MBI and FMA r=0.8, 0.81, 0.78, 0.8; MBI and BBS r =0.89, 0.94, 0.9, 0.91 respectively).

Known Groups:
No studies have examined the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the BI in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Responsiveness

Wood-Dauphinee, Williams and Shapior (1990) compared the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BI to the Fugl-Meyer Assessment (FMA) in 167 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Patients were assessed at admission to hospital and at 5-weeks post-stroke. The correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between mean change in FMA Upper and Lower Extremity Motor subscores and total Barthel Indice scores was adequate (r = 0.57), as calculated using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. The FMA and BI were both found to have small effect sizes (ES = 0.24 and 0.42 respectively) from admission to 5-weeks post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The results of this study suggest that both measures have poor responsivenessThe ability of an instrument to detect clinically important change over time.
with the BI being more sensitive to detecting change that the FMA.

Salbach and coll. (2001) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BI, Timed Up and Go (TUG), Berg Balance Scale (BBS), 10 meter walk test (10mWT) and 5 meter walk test (5mWT) in 50 patients with residualgait deficits after a first-time strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The BI, BBS 5mWT and 10mWT demonstrated large effect sizes and the TUG demonstrated a moderate effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
, between 8 days and 38 days post-stroke, as calculated using standardized response means (SRM = 0.99, 1.04, 1.22, 0.92 and 0.73 respectively).

Hsueh, Lin, Jeng, and Hsieh (2002) compared the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BI, 5-item short form BI (BI-5) and motor-FIM in 118 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. undergoing treatment on an inpatient rehabilitation unit. The BI, BI-5 and motor-FIM all exhibited high responsivenessThe ability of an instrument to detect clinically important change over time.
, as calculated using standardized response meanThe standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.
(SRM) (BI=1.2; 5-BI=1.2; motor-FIM=1.3) indicating significant sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
for detecting change.

Wallace, Duncan, and Lai (2002) compared the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BI to that of the motor-FIM for recovery following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Change was measured using the Modified Rankin Scale. The BI and motor-FIM were administered to 372 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. at one and three months following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The BI and motor-FIM were both found to have small effect sizes (ES = 0.31 and 0.28 respectively), indicating similar responsivenessThe ability of an instrument to detect clinically important change over time.
between the measures.

Van der Putten, Hobart, Freeman and Thompson (1999) compared the responsivenessThe ability of an instrument to detect clinically important change over time.
of the MBI to that of the motor and cognitive components of the FIM and the FIM total score in 201 patients with multiple sclerosis and 82 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. undergoing inpatient neuro-rehabilitation. The MBI and the total-FIM and motor-FIM all demonstrated large effect sizes for patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (ES = 0.95, 82, 91 respectively) and the cognitive-FIM demonstrated an adequate effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
(ES = 0.61). Change in scores for all scales in both disease groups were positive, indicating less disability on discharge than admission. Effect sizes on the MBI were similar to those of the FIM in both patient groups.

Hsueh, Lee and Hsieh (2001) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the MBI in 121 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The MBI was administered at 14, 30, 90 and 180 post-stroke. Standardized effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
scores were calculated for the intervals between 14-30 days, 30-90 days, 90-180 days and 14-180 days. The MBI demonstrated moderate to large effect sizes for all intervals, except for the 90-180 days post-stroke interval (ES = 0.56, 0.53, 0.11 and 1.27 respectively). The largest effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
was 14-180 days post-stroke, indicating that the MBI is most sensitive to detecting change in ADL function over longer periods of time.

Dromerick, Edwards, and Diringer (2003) examined responsivenessThe ability of an instrument to detect clinically important change over time.
of the MBI and the FIM in a sample of 95 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. on admission to and discharge from a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation service. The Modified Rankin Scale and the International StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Trial Measure were used to measure disability. The FIM was found to be more responsive to change from admission to discharge than the MBI, as calculated using the standardized response meanThe standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.
(SRM) (SRM= 2.18 vs. 1.72). The MBI detected change in 71/95 subjects but demonstrated ceiling effects with 27% of subjects scoring >95. The results of this study found the FIM to be the most sensitive of the four measures, detecting change in 91/ 95 patients, including change in 18 patients in whom the MBI detected no change.

Schepers, Ketelaar, Visser-Meily, Dekker and Lindeman (2006) investigated the responsivenessThe ability of an instrument to detect clinically important change over time.
of the MBI, FIM, Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Indice (FAI), and StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Adapted Sickness Impact Profile 30 (SA-SIP30). The four measures were administered to 163 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. at admission to inpatient rehabilitation and at 6-months and 1-year post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The MBI and the FIM total and motor scores were found to have a large effect sizes at 6-months post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (ES 0.98, 0.84 and 0.89 respectively) and a moderate effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
at 1-year post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (ES = 0.52, 0.47 and 0.51 respectively). The FIM cognitive score was found to have a moderate effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
at both 6-months and 1-year post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (ES = 0.47 at both time points). The SASIP30 and FAI demonstrated moderate effect sizes at 1-year post stoke (ES = 0.63 and 0.59 respectively). Results of this study indicate that the MBI and FIM (total and motor) are most apt to detect change in the subacute phase.
Note: The effect sizes for the SIP30 and FAI were not calculated at 6-months post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. due to insufficient data. The FAI was only administered to patients who resided at home during the time of testing as the measure pertains to function relating daily housekeeping and activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
typically performed outside of the rehabilitation or hospital environment.

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Copyright  Information:
The  Maryland  State  Medical  Society  (https://www.medchi.org/)  holds  the  copyright  for  the  Barthel  Index.    It  may  be  used  freely  for  non commercial  purposes  with  the  following  citation: Mahoney  FI,  Barthel  D.    “Functional  evaluation:  the  Barthel  Index.” Maryland  State  Med  Journal  1965;14:56-61.   Used  with  permission. Permission  is  required  to  modify  the  Barthel  Index  or  to  use  it  for  commercial  purposes.