Activity Index – A Complementary ADL Scale to the Barthel Index in the Acute Stage in Patients with Severe Stroke

Abstract

Objective: It was the aim of this study to compare the Barthel Index (BI) and the activities of daily living (ADL) component of the Activity Index [AI(ADL)] regarding floor and ceiling effects, responsiveness and the predictive value for survival during the first week until 3 months after stroke onset. Patients and Methods: Basic ADL were assessed in 75 patients with ischaemic stroke. Results: There was a strong concordance between BI and AI(ADL) scores at all time points (Kendall’s τ_b = 0.7878, p < 0.0001 at baseline; Kendall’s τ_b = 0.8901, p < 0.0001 at 1 week; Kendall’s τ_b = 0.9027, p < 0.0001 at 3 months). BI had a significantly more pronounced floor effect at baseline and at 1 week compared with AI(ADL) in patients with severe stroke. Both scales had a substantial ceiling effect at 3 months. At 1 week, the baseline BI score was significantly higher in patients being alive as compared with those who had died, while their AI(ADL) score did not differ significantly. At 3 months, baseline BI and AI(ADL) scores were significantly higher in patients being alive as compared with those who had died. The predictive value of being alive at 1 week and 3 months did not differ between BI and AI(ADL). Conclusion: AI(ADL) is recommended to be used in addition as a complement to BI in patients with severe stroke since the floor effect with BI in the acute stage is significantly more pronounced than with AI(ADL), thus hampering the responsiveness.