TY - JOUR
T1 - Measurement Properties of the Barthel Index in Geriatric Rehabilitation
AU - Bouwstra, Hylco
AU - Smit, Ewout B.
AU - Wattel, Elizabeth M.
AU - van der Wouden, Johannes C.
AU - Hertogh, Cees M. P. M.
AU - Terluin, Berend
AU - Terwee, Caroline B.
PY - 2019/4
Y1 - 2019/4
N2 - Objective: The Barthel index (BI) is a widely used observer-based instrument to measure physical function. Our objective is to assess the structural validity, reliability, and interpretability of the BI in the geriatric rehabilitation setting. Design: Two studies were performed. First, a prospective cohort study was performed in which the attending nurses completed the BI at admittance and discharge (n = 207). At discharge, patients rated their change in physical function on a 5-point Likert rating scale. To assess the internal structure of the BI, a confirmatory factor analysis was performed. Unidimensionality was defined by comparative fit index and Tucker-Lewis index of >0.95, and root mean square error of approximation of <0.06. To evaluate interpretability, floor/ceiling effects and the minimal important change (MIC) were assessed. Predictive modeling was used to calculate the MIC. The MIC was defined as going home and minimal patient-reported improvement defined as slightly or much improved physical function, which served as anchors to obtain a clinical- and patient-based MIC. A second group of 37 geriatric rehabilitation patients were repeatedly assessed by 2 attending nurses to assess reliability of the BI. The intraclass correlation coefficient, standard error of measurement, and smallest detectable change were calculated. Setting and Participants: Patients receiving inpatient geriatric rehabilitation admitted to 11 Dutch nursing homes (n = 244). Results: Confirmatory factor analysis showed partly acceptable fit of a unidimensional model (comparative fit index 0.96, Tucker-Lewis index 0.95, and root mean square error of approximation 0.12). The clinical-based MIC was 3.1 [95% confidence interval (CI) 2.0–4.2] and the patient-based MIC was 3.6 (95% CI 2.8–4.3). The intraclass correlation coefficient was 0.96 (95% CI 0.93–0.98). The standard error of measurement and smallest detectable change were 1.1 and 3.0 points, respectively. Conclusions/Implications: The structural validity, reliability, and interpretability of the BI are considered sufficient for measuring and interpreting changes in physical function of geriatric rehabilitation patients.
AB - Objective: The Barthel index (BI) is a widely used observer-based instrument to measure physical function. Our objective is to assess the structural validity, reliability, and interpretability of the BI in the geriatric rehabilitation setting. Design: Two studies were performed. First, a prospective cohort study was performed in which the attending nurses completed the BI at admittance and discharge (n = 207). At discharge, patients rated their change in physical function on a 5-point Likert rating scale. To assess the internal structure of the BI, a confirmatory factor analysis was performed. Unidimensionality was defined by comparative fit index and Tucker-Lewis index of >0.95, and root mean square error of approximation of <0.06. To evaluate interpretability, floor/ceiling effects and the minimal important change (MIC) were assessed. Predictive modeling was used to calculate the MIC. The MIC was defined as going home and minimal patient-reported improvement defined as slightly or much improved physical function, which served as anchors to obtain a clinical- and patient-based MIC. A second group of 37 geriatric rehabilitation patients were repeatedly assessed by 2 attending nurses to assess reliability of the BI. The intraclass correlation coefficient, standard error of measurement, and smallest detectable change were calculated. Setting and Participants: Patients receiving inpatient geriatric rehabilitation admitted to 11 Dutch nursing homes (n = 244). Results: Confirmatory factor analysis showed partly acceptable fit of a unidimensional model (comparative fit index 0.96, Tucker-Lewis index 0.95, and root mean square error of approximation 0.12). The clinical-based MIC was 3.1 [95% confidence interval (CI) 2.0–4.2] and the patient-based MIC was 3.6 (95% CI 2.8–4.3). The intraclass correlation coefficient was 0.96 (95% CI 0.93–0.98). The standard error of measurement and smallest detectable change were 1.1 and 3.0 points, respectively. Conclusions/Implications: The structural validity, reliability, and interpretability of the BI are considered sufficient for measuring and interpreting changes in physical function of geriatric rehabilitation patients.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85056450580&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30448338
U2 - https://doi.org/10.1016/j.jamda.2018.09.033
DO - https://doi.org/10.1016/j.jamda.2018.09.033
M3 - Article
C2 - 30448338
SN - 1525-8610
VL - 20
SP - 420-425.e1
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 4
ER -