Measurement Properties of the Barthel Index in Geriatric Rehabilitation
Measurement Properties of the Barthel Index in Geriatric Rehabilitation
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DOI：
10.1016/j.jamda.2018.09.033
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发表时间：
2019-04-01
影响因子：
7.6
通讯作者：
Terwee, Caroline B.
中科院分区：
文献类型：
--
作者：
Bouwstra, Hylco;Smit, Ewout B.;Terwee, Caroline B.
目的：Barthel指数(BI)是一种广泛使用的以观察者为基础的身体机能测量工具。我们的目标是评估BI在老年康复环境中的结构效度、可靠性和可解释性。设计：进行两项研究。首先，进行了一项前瞻性队列研究，其中主治护士在入院和出院时完成了BI(n=207)。出院时，患者用5分Likert评分表对身体功能的变化进行评分。为了评估BI的内部结构，进行了验证性因素分析。通过比较拟合度指数和Tucker-Lewis指数的0.95和近似均方根误差的0.06来定义单维度。为了评估可解释性，评估了地板/天花板效应和最小重要变化(MIC)。采用预测模型计算最低抑菌浓度。MIC被定义为回家，患者报告的最小改善定义为身体功能略有或显著改善，作为获得临床和患者基础MIC的锚。第二组37名老年康复患者由2名主治护士重复评估，以评估BI的可靠性。地点和对象：在11家荷兰养老院接受老年康复治疗的患者(n=244)。结果：验证性因素分析显示一维模型的部分可接受的拟合度(相对拟合度指数0.96，Tucker-Lewis指数0.95，近似均方误差0.12)。临床MIC为3.1[95%可信区间(CI)2.0~4.2]，患者MIC为3.6(95%CI 2.8~4.3)。组内相关系数为0.96(95%可信区间为0.93~0.98)。测量的标准误差和最小可检测变化分别为1.1分和3.0分。结论/暗示：BI的结构效度、信度和可解释性被认为足以测量和解释老年康复患者的身体功能变化。(C)2018年AMDA--急性后和长期护理医学学会。
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 patientreported 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. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.