Abstract

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.
Original languageEnglish
Pages (from-to)420-425.e1
JournalJournal of the American Medical Directors Association
Volume20
Issue number4
DOIs
Publication statusPublished - Apr 2019

Cite this

@article{c05a58afba6d4608aa24d4044caadee1,
title = "Measurement Properties of the Barthel Index in Geriatric Rehabilitation",
abstract = "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.",
author = "Hylco Bouwstra and Smit, {Ewout B.} and Wattel, {Elizabeth M.} and {van der Wouden}, {Johannes C.} and Hertogh, {Cees M. P. M.} and Berend Terluin and Terwee, {Caroline B.}",
year = "2019",
month = "4",
doi = "10.1016/j.jamda.2018.09.033",
language = "English",
volume = "20",
pages = "420--425.e1",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",
number = "4",

}

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 - 10.1016/j.jamda.2018.09.033

DO - 10.1016/j.jamda.2018.09.033

M3 - Article

VL - 20

SP - 420-425.e1

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 4

ER -