Relationship between the modified Rankin Scale and the Barthel Index in the process of functional recovery after stroke

Article type: Research Article

Authors: Cioncoloni, D.^{a; b} | Piu, P.^c | Tassi, R.^d | Acampa, M.^d | Guideri, F.^d | Taddei, S.^a | Bielli, S.^a | Martini, G.^d | Mazzocchio, R.^{e; *}

Affiliations: [a] U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy | [b] Scuola di Dottorato in Scienze Cognitive, Universitá degli Studi di Siena, Siena, Italy | [c] Scuola di Dottorato in Scienze Neurologiche Applicate, Sezione di Neuroscienze, Università degli Studi di Siena, Siena, Italy | [d] Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy | [e] S.C. Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese, Siena, Italy

Correspondence: [*] Corresponding author: Dr. R. Mazzocchio, S.C. Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese, Viale Bracci, I-53100 Siena, Italy. Tel.: +39 0577 233409; Fax: +39 0577 40327; E-mail: mazzocchio@unisi.it

Abstract: Objective:The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most common clinimetrical instruments for measuring disability after stroke. This study investigated the relationship between the BI and the mRS at multiple time points after stroke. The BI, which is a widely used instrument for longitudinal follow-up post-stroke, was used as reference to determine the effect of time on the sensitivity of the mRS in differentiating functional recovery. Methods:Ninety-two patients with first stroke and hemispheric brain lesion were evaluated using the BI and mRS at 10 days, 3 and 6 months. The Kruskal–Wallis test was applied to examine median differences in BI among the mRS levels at 10 days, 3 and 6 months with Dunn’s correction for multigroup comparison. The Mann and Whitney test was used to compare median differences in BI scores between two aggregations of mRS grades (mRS = 0–2, mRS = 3–5) at the same time periods after stroke. Results:BI score distribution amongst mRS grades overlapped at 10 days, differentiating only between extreme grades (no disability vs severe disability). At 3 months, independent patients with slight disability could be distinguished from dependent patients with marked disability. At 6 months, grade 2 and 3 overlapped no more, differentiating independence (class 0–2) from dependence (class 3–5). The largest transition to an independent functional status occurred from grade 4, at 3 months. Conclusion:Maximum sensitivity of mRS in differentiating functional recovery is reached at six months post-stroke.

Keywords: Stroke, Barthel Index, modified Rankin Scale, rehabilitation, physiotherapy, functional recovery, prognosis

DOI: 10.3233/NRE-2012-0761

Journal: NeuroRehabilitation, vol. 30, no. 4, pp. 315-322, 2012