Objective: To compare the appropriateness and responsiveness of the Barthel Index and the Functional Independence Measure (FIM) during early inpatient rehabilitation after single incident brain injury.
Design: Cohort study.
Setting: A regional neurological rehabilitation unit.
Patients: Two hundred and fifty-nine consecutive patients undergoing inpatient comprehensive neurological rehabilitation following a vascular brain injury due to single cerebral infarction (n=75), spontaneous intracerebral haemorrhage (n=34) and subarachnoid haemorrhage (n=43), and 107 patients who had sustained traumatic brain injury.
Measurements: Admission and discharge FIM total, physical and cognitive scores and the Barthel Index were recorded. Appropriateness and responsiveness in the study samples were determined by examining score distributions and floor and ceiling effects, and by an effect size calculation respectively. Non-parametric statistical analysis was used to calculate the significance of the change in scores.
Results: In all patient groups there was a significant improvement (Wilcoxon's rank sum, P < 0.0001) in the Barthel Index (mean change score: vascular 3.9, traumatic 3.95) and FIM (mean change score: vascular 17.3, traumatic 17.4) scores during rehabilitation, and similar effect sizes were found for the Barthel Index (effect size: vascular 0.65, traumatic 0.55) and FIM total (effect size: vascular 0.59, traumatic 0.48) and physical scores in all patient groups. In each patient group the cognitive component of the FIM had the smallest effect size (0.35-0.43).
Conclusions: All measures were appropriate for younger (less than 65 years of age) patients undergoing early inpatient rehabilitation after single incident vascular or traumatic brain injury. The Barthel Index and the total and physical FIM scores showed similar responsiveness, whilst the cognitive FIM score was least responsive. These findings suggest that none of the FIM scores have any advantage over the Barthel Index in evaluating change in these circumstances.
Get full access to this article
View all access options for this article.
References
1.
1 Hoffman C, Rise D, Sung H-Y. Persons with chronic conditions. Their problems and costs. JAMA1996; 276: 1473–1479.
2.
2 McMillan TM, Greenwood RJ. Models of rehabilitation programmes for the brain injured adult. II: model services and suggestions for change in the UK. Clin Rehabil1993; 7: 346–355.
3.
3 Turner-Stokes L (ed.). Rehabilitation following acquired brain injury: national clinical guidelines. Royal College of Physicians and British Society of Rehabilitation Medicine, 2003.
4.
4 Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J1965; 14: 61–65.
5.
5 Granger C, Hamilton B, Keith RA, Zielezny M, Sherwin FS. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil1986; 1: 59–74.
6.
6 Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992.
7.
7 Hsueh IP, Lin JH, Jeng JS, Hsieh CL. Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke. J Neurol Neurosurg Psychiatry2002; 73: 188–190.
8.
8 Wallace D, Duncan PW, Lai SM. Comparison of the responsiveness of the Barthel Index and the motor component of the Functional Independence Measure in stroke: the impact of using different methods for measuring responsiveness. J Clin Epidemiol2002; 55: 922–928.
9.
9 Granger CV, Cotter AC, Hamilton BB, Fiedler RC. Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil1993; 74: 133–138.
10.
10 Corrigan JD, Smith-Knapp K, Granger CV. Validity of the Functional Independence Measure for persons with traumatic brain injury. Arch Phys Med Rehabil1997; 78: 828–834.
11.
11 Desrosiers J, Rochette A, Noreau L, Bravo G, Hebert R, Boutin C. Comparison of two functional independence scales with a participation measure in post-stroke rehabilitation. Arch Gerontol Geriatr2003; 37: 157–172.
12.
12 O'Connor RJ, Cano SJ, Thompson AJ, Hobart JC. Exploring rating scale responsiveness: does the total score reflect the sum of its parts?Neurology2004; 62: 1842–1844.
13.
13 Dromerick AW, Edwards DF, Diringer MN. Sensitivity to changes in disability after stroke: a comparison of four scales useful in clinical trials. J Rehabil Res Dev2003; 40: 1–8.
14.
14 Kwon S, Hartzema AG, Duncan PW, Min-Lai S. Disability measures in stroke: relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke2004; 35: 918–923.
15.
15 van der Putten JJM, Hobart JC, Freeman JA, Thompson AJ. Measuring in change after the disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry1999; 66: 480–484.
16.
16 Edwards MJ, McNeil J, Greenwood RJ. Process and outcome during early inpatient rehabilitation after brain injury. Disabil Rehabil2003; 25: 405–410.
17.
17 Novak S, Johnson J, Greenwood R. Barthel revisited: making guidelines work. Clin Rehabil1996; 10: 128–134.
18.
18 Holmes W, Shea J, Performance of a new HIV/AIDS-targeted quality of life (HAT-QoL) instrument in asymptomatic seropositive individuals. Qual Life Res1997; 6: 561–571.
19.
19 Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care1989; 27(suppl 3): S178–S189.
20.
20 Bates BE, Stineman MG. Outcome indicators for stroke: application of an algorithm treatment across the continuum of postacute rehabilitation services. Arch Phys Med Rehabil2000; 81: 1468–1478.
21.
21 Corrigan JD, Smith-Knapp K, Granger CV. Outcomes in the first 5 years after traumatic brain injury. Arch Phys Med Rehabil1998; 79: 298–305.
22.
22 Eng JJ, Rowe SJ, McLaren LM. Mobility status during inpatient rehabilitation: a comparison of patients with stroke and traumatic brain injury. Arch Phys Med Rehabil2002; 83: 483–490.
23.
23 McPherson KM, Pentland B. Disability in patients following traumatic brain injury –which measure?Int J Rehabil Res1997; 20: 1–10.
24.
24 Turner-Stokes L. Outcome measurement in brain injury rehabilitation –towards a common language. Clin Rehabil1999; 13: 273–275.
25.
25 Hobart JC, Lamping DL, Thompson AJ. Measuring disability in neurological disease: validity of the self-report Barthel index [abstract]. J Neurol1996; 243(suppl 2): S25-S25.
