The Advantage of the Barthel Index - Essay Example

? Barthel Index Barthel Index (BI) is an ordinal scale for functional assessment of disability that has been widely used with the patients who suffer from neuromuscular and musculoskeletal conditions ( Sainsbury, SeeBass, Bansal, Young, 2005). The index has been widely applied since 1955 by nurses and rehabilitation therapist to examine patients prior to admission and following discharge (Mahoney, Barthel 1965). There are two types of the Barthel index: the original Barthel index scored in steps of five points to give a maximum total of 100 scores and the modified index that includes a revised, score range of 0-20. For each Item listed in the index there are assigned values based on time and the amount of the actual physical assistances required, if the patient is unable to perform a task (Mahoney, Barthel, 1996). Full credit is not given for an activity, if the patient needs even minimal assistances or cannot perform an activity without someone present in the room. The Barthel Index is designed to measure the patient’s ability to perform independently the following ten daily life activities: bowel, transfer, bladder, mobility, grooming, dressing, toilet use, stairs, feeding and bathing. After the test is administered to the patient Barthel Index scores will be summed up to give a possible range from 0-20. The scores for each item vary from 0 - the patient is dependent, 1 - the patient need major help, 2 - the patient need minor help, and 3 - the patient is fully independent. The lower overall scores usually indicate increase in patient’s disability (Collin et al. 1988). To measure how well the patient has progressed towards independences the Barthel index should be applied at the beginning of the rehabilitation treatment and at intervals during the course of his or her rehabilitation (Mahoney, Barthel, 1996). Usually the lack of improvement in the Barthel Index scores after a reasonable period of rehabilitation treatment indicates poor potential for rehabilitation. Moreover, while administering the Barthel Index each therapist should take into account the fact that some environmental conditions might affect the patient’s scores. For example, if the patent has special requirements other than the home usual setting, his or her score might be affected, if these requirements are not met (grab bars in the toilet and tub and wide doorways to allow easy access of the wheelchair, etc). Furthermore, general guidelines have been established to assist rehabilitation therapist or the nurses during the scoring process, while administering the assessment tool. For example the general guidelines suggested that a therapist should record what a patient does, but should not record what a patient could do. Additionally, the patient’ performance should be established by using the best available evidences such as asking the patient, family and nurses, who attend the patient during his or her hospital stay, or by the direct supervision with the help of the assessment tool administrator. The guidelines also states that the need for supervision testifies that the patient is not independent (Collin et al .1988). The administration of the brothel index can be implemented in several ways such as interview face to face or on the telephone, observation of the patients’ performances in the care setting, and by asking the patient to demonstrate an activity (Sainbury, Seebass, Bansal, & Young. 2005). Several studies were conducted to justify the reliability and the validity of the Barthel Index (Sainbury, Seebass, Bansal, & Young. 2005). In 2006 a study was comducted by Houlden, H., Edwards, M., McNeil, J., & Greenwood, R. to compare the appropriateness and responsiveness of the Barthel Index and the Functional Independence Measure (FIM). The research studied 259 patients, who were undergoing inpatient comprehensive neurological rehabilitation following a vascular brain injury due to single cerebral infarction (n=75), spontaneous intracerbral hemorrhage (n=34), and subarachnoid hemorrhage (n=43), and 107 patients, who had sustained traumatic brain injury. Each patient who participated in the study was rated by a multidisciplinary team using different rehabilitation tools The Barthel Index and Functional Independence Measure. The study revealed that The Barthel Index and the total FIM scores showed similar responsiveness, however, the cognitive FIM scores was less responsive. Additionally the findings suggested that none of the FIM scores have any advantage over the Barthel Index in evaluating changes following a vascular brain injury. Nevertheless, the results of this study showed the advantages of using Brothel Index over the Functional Independence Measure. The scholars have listed some major limitation that has to be considered before generalizing the result. For example, the scholars stated that the patients were not randomly selected, test- retest was not examined and there was a disadvantage of simultaneous scoring of the two measures, and finally their data were obtained in single rehabilitation unit (Houlden, H., Edwards, M., McNeil, J., & Greenwood, R., 2006). Another systematic review of recent studies implemented by Sainsbury, A., Seebass, G., Bansal, A., & Young, J. B. (2005) investigated the reliability of the Barthel Index in the functional assessment of older people. The research was conducted by two scholars and included 12 studies out of the 1857 identified abstracts. The results of this review suggested that there was evidence that the Barthel index might be less reliable un patients with cognitive impartment. However, the inter-rater reliability was reported fair to moderate for individual items and high percentage agreement for the total Barthel index score. In addition this study concluded that the reliability of the Barthel Index needs further research. The study, which investigated the Validity and Reliability of the Barthel Index Administered by Telephone was conducted by Della Pietra, G. L., Savio, K., Oddone, E., Reggiani, M., Monaco, F., & Leone, M. A. (2011). According to the research, “one hundred thirty- one patients were interviewed twice by 2 registered nurses with the identical level training. Half of the patients were randomized to receive the telephone interview followed by the face-to-face interview” (Della Pietra et al, 2011). The result of this study showed that telephone assessment of stroke disability is more reliable in comparison to face to-face assessment. The study sensitivity ranged from 88% to 100% and testified that the telephone administered BI, is as valid as the Face to-Face interview. The major limitation of the study lied in the fact that the results from hospital setting might not be immediately transferred to interviews obtained at home setting, where the Barthel Index is mostly used. Finally, the advantage of the Barthel Index lies in it is simplicity and it usefulness in evaluation the patients’ state of independence before the treatment is initiated and during the treatment. The Barthel Index can be easily applied by all the rehabilitation clinicians. The Barthel Index is a valuable tool due to the ability to breakdown the items to highlight the area of deficiency. References Mahoney, F, Barthel D. (1965). Functional evaluation: the Barthel index. Maryland state medical journal, 14, 61-65. Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: a reliability study. Disability & Rehabilitation, 10(2), 61-63. Della Pietra, G. L., Savio, K., Oddone, E., Reggiani, M., Monaco, F., & Leone, M. A. (2011). Validity and reliability of the Barthel index administered by telephone. Stroke, 42(7), 2077-2079. Houlden, H., Edwards, M., McNeil, J., & Greenwood, R. (2006). Use of the Barthel Index and the Functional Independence Measure during early inpatient rehabilitation after single incident brain injury. Clinical rehabilitation, 20(2), 153-159. Sainsbury, A., Seebass, G., Bansal, A., & Young, J. B. (2005). Reliability of the Barthel Index when used with older people. Age and Ageing, 34(3), 228-232 Read More