Disability assessment in stroke: Relationship among the pictorial-based Longshi Scale, the Barthel Index, and the modified Rankin Scale

Abstract

Objective: To explore the correlations among the Longshi Scale, the Barthel Index, and the modified Rankin Scale and the differentiate ability of the Longshi Scale and the modified Rankin Scale to Barthel Index scores. Design: Prospective study. Setting: The inpatient rehabilitation units of three teaching hospitals in China. Subjects: A total of 343 stroke inpatients were recruited through convenience sampling. Main measures: Pictorial-based Longshi Scale, Barthel Index, and modified Rankin Scale. Results: The Longshi Scale was highly and moderately correlated with the Barthel Index and modified Rankin Scale, respectively. The median frequency distribution of the Barthel Index was slightly overlapped between Longshi Scale grades 2 and 3 but was considerably overlapped among modified Rankin Scale grades 1, 2, and 3. The Kruskal-Wallis and multiple comparison tests showed that, among the modified Rankin Scale grades, the median Barthel Index scores did not differentiate between grades 1 and 2 (χ2 = 20.643, P = 1.000), between grades 1 and 3 (χ2 = 60.404, P = 0.070), and between grades 2 and 3 (χ2 = 39.760, P = 0.232). Among the Longshi Scale grades, the median Barthel Index scores did not differentiate between grades 2 and 3 (χ2 = 48.778, P = 1.000), between grades 3 and 4 (χ2 = 57.094, P = 1.000), and between grades 5 and 6 (χ2 = 24.709, P = 1.000). Conclusion: Using the Barthel Index as reference, the proposed Longshi Scale has better ability than the modified Rankin Scale in differentiating stroke patients’ disability, especially for those with higher level of activities of daily living.