New research: a shorter test to measure activities of daily living after stroke

Published: Friday 3 February 2017

What are basic activities of daily living (ADL) and why are they important?

After a stroke, many stroke survivors struggle with basic activities of daily living (ADL), which are self-care tasks that include being able to walk and get around, bathing, dressing, feeding, and grooming oneself and being able to go to the toilet.

What is the Barthel Index (BI)?

To help plan the care of stroke survivors and their rehabilitation, health professionals usually use a scale called the Barthel Index (BI) to measure how well they can perform ADLs. The BI consists of ten scored items that relate to basic ADLs and each item is scored on how well a patient is able to complete it or not.

Although the BI has proven useful, an NHS England and Wales National Stroke Audit found the completion rate of the scale in clinical care to be about 60%. Lack of time was cited as the reason for poor completion with patients (which is not an uncommon finding for similar assessment scales).

What does the new research show?

Published in the journal, Stroke, new research into the BI suggests that a shortened version of the scale may be more suitable for use with stroke survivors when they take part in research trials, or as part of audits of clinical care. The new research consists of a systematic review and analysis of previous research.

The researchers used their systematic review to identify studies which used shortened versions of the BI reliably and effectively. They then tested and compared the various short forms of the BI. To do this they used a database called the Virtual International Stroke Trials Archive (VISTA). VISTA contains information on thousands of patients who have completed stroke studies. Using the VISTA data, the researchers compared each short form BI to the traditional longer version and then assessed the agreement between each short form and various other measures of recovery.  

A shortened version of the BI was identified, consisting of three items (moving from bed to chair and back, walking on a level surface, and bladder control), which showed high agreement with the full version (ten items), patient outcomes, and which may prove quicker and easier to administer to stroke survivors. 

The next step in the research would be to describe whether there is any additional benefit of the short version of the BI to stroke survivors over the full version, in terms of how feasible it is to administer to patients, how acceptable it is to patients and health professionals, and how much of the scale is completed.

The researchers acknowledge that for the clinical assessment of individual patients, the full BI scale would still provide more information about their ability to perform basic ADLs than the shortened version, and may still be used for that purpose. However, it is hoped that in research trials, and in audits of clinical care, where the purpose is to collect information about many patients, the short version may prove to be the more appropriate scale to use. It may save valuable time that can be directed at the clinical care of the patient.

What do the researchers say?

Dr Terry Quinn, University of Glasgow, and principal researcher on the study said:

"Stroke research relies on the participation and goodwill of people affected by stroke. We are always looking for ways to make the research process easier and less burdensome for participants. Our research suggests that a very short questionnaire could be just as good a measure of stroke recovery for research studies as longer, more time-consuming tests."

Funding

This work was funded by Greater Glasgow and Clyde Endowments. Principal researcher, Dr Terry Quinn is supported by a Stroke Association/Chief Scientist Office Senior Clinical Lectureship.

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