Barthel revisited: making guidelines work

Abstract

The Barthel Index (Bl) is a weighted and summed index designed to reflect a patient's dependency on carers. The aims of this study were first, to establish the validity of the Bl in a patient group whose disability resulted from cognitive as well as physical impairment, a combination frequently encountered in patients with brain injuries other than simple stroke. Secondly, a way was desired of using the Bl which, in a rehabilitation unit with both experienced and inexperienced staff, was less contentious and thus reliable. It was found that issuing guidelines along with the standard definitions did not wholly achieve this end. Instead, through discussions as a multidisciplinary team, scoring definitions were evolved which, although including the original definitions, were more comprehensive and specifically addressed those areas which had hitherto been contentious in respect of the patient group. As a measure of validity the amount of carer time each patient required in a 24- hour period was recorded and correlated against the Bl score. Preliminary data demonstrate that the Bl, in this form, retains validity and inter-rater reliability when used with patients after brain injuries of all sorts.