Comparison of the Psychometric Characteristics of the Functional Independence Measure, 5 Item Barthel Index, and 10 Item Barthel Index in Patients with Stroke

Abstract

Objectives: The 5-item short form Barthel Index (BI-5) has been shown to be a potentially useful measure of activities of daily living (ADL). The purpose of this study was to compare the reliability, validity and responsiveness of the motor subscale of the Functional Independence Measure (FIMTM ), the original 10-item BI, and the BI-5 in stroke inpatients receiving rehabilitation. Methods: A total of 118 stroke inpatients at a rehabilitation unit participated in the study. The patients were tested using the FIM motor subscale and original BI at admission to the rehabilitation ward and before discharge from the hospital. The distribution, internal consistency, concurrent validity, and responsiveness of each measure were examined. Results: The BI and FIM motor subscale showed acceptable distribution, high internal consistency ( alpha coefficient& sup3;0.84), high concurrent validity (Spearman rho&sup3 ;0.92, intraclass correlation coefficient (ICC) &sup3; 0.83) and high responsiveness (standardized response mean &sup3;1.2, p <0. 001). The BI-5 exhibited a notable floor effect at admission , but this was not found at discharge. The BI-5 showed acceptable internal consistency at admission and discharge ( alpha coefficient&sup3;0.71). The concurrent validity of the BI-5 was poor to fair at admission (rho=0.74, ICC&pound; 0. 55), but was good at discharge (rho&sup3;0.92, ICC&sup3; 0.74). It is noted that the responsiveness of the BI-5 was as high as that of the BI and FIM motor subscale. Conclusions: The results demonstrated that the BI and FIM motor subscale had very acceptable and similar psychometric characteristics. The BI-5 appeared to have limited discriminative ability at admission, particularly for patients with severe disability; otherwise the BI-5 showed very adequate psychometric properties. These results may provide information useful in the selection of ADL measures for both clinicians and researchers.