Early Rehabilitation Barthel Index Research Articles

Does the APACHE II score predict performance of activities of daily living in patients discharged from a weaning center?

IntroductionData regarding the functional status of patients after prolonged mechanical ventilation are scarce, and little is known about its clinical predictors.AimTo investigate whether the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission may predict performance in activities of daily living on discharge from a weaning center.Material and methodsAll consecutive patients admitted between January 1, 2012 and December 31, 2013 were enrolled (n = 130). During this period, 15 subjects died, and 115 were successfully discharged (34 women; 81 men). APACHE II was calculated based on the worst values taken during the first 24 hours after admission. On discharge, the Barthel Index (BI) and its extended version, the Early Rehabilitation Barthel Index (ERBI), were assessed.ResultsMedian BI was 20 points (IQR 5; 40), and ERBI was 20 points (–50; 40). There was no correlation between APACHE II and either BI (R = –0.07; p = 0.47) or ERBI (R = –0.07; p = 0.44). APACHE II predicted the need for assistance with bathing (AUROC = 0.833; p < 0.001), grooming (AUROC = 0.823; p < 0.001), toilet use (AUROC = 0.887; p < 0.001), and urination (AUROC = 0.658; p = 0.04). APACHE II had no impact on any ERBI items associated with ventilator weaning, including the need of further mechanical ventilation (AUROC = 0.534; p = 0.65) or tracheostomy (AUROC = 0.544; p = 0.42).ConclusionsAlthough APACHE II cannot predict the overall functional status in patients discharged from a weaning center, it helps identify subjects who will need support with bathing, grooming, and toilet use. The APACHE II score is inadequate to predict performance in activities associated with further respiratory support.

The Early Functional Abilities (EFA) scale to assess neurological and neurosurgical early rehabilitation patients.

BackgroundIt is difficult to assess neurological and neurosurgical early rehabilitation patients comprehensively. Available scales focus on activities of daily living (Barthel (BI) and Early Rehabilitation Barthel Index (ERBI)) or wakefulness (Glasgow Coma Scale (GCS), Coma Remission Scale (CRS)) while cognitive items are missing.MethodsThe Early Functional Abilities (EFA) scale comprises 20 items referring to activities of daily living (ADL), wakefulness and cognitive abilities. To evaluate its validity, n = 623 early neurological and neurosurgical rehabilitation patients (most of them after ischemic stroke or cerebral bleeding) were assessed on admission using the EFA, ERBI, GCS, CRS and measures of morbidity (co-diagnoses).ResultsThe more co-diagnoses the lower EFA sum scores were obtained (Spearman-Rho rs = -0.509, p < 0.001). EFA predicted length of stay (LOS, rs = -0.565, p < 0.001) and BI at discharge (rs = 0.571, p < 0.001).ConclusionsThe results suggest that EFA is a valid instrument to assess critically ill neurological and neurosurgical early rehabilitation patients. It may be used as a measure of morbidity and a predictor of LOS and outcome. Further studies are strongly encouraged.

Versuch einer Operationalisierung und praxisorientierten Erweiterung des Frühreha-Indexes („niedersächsischer Frühreha-Index“)

This paper suggests an operationalization of the items of the early rehabilitation Barthel-index (ERBI). In addition, it presents a modification of this instrument, called lower-saxony ERBI (lsERBI). In order to validate the lsERBI, it has been used in 273 neurological rehabilitants. Findings suggest that the lsERBI has a higher specificity but lower sensitivity than the conventional ERBI. Inter-rater-reliability was high (r=0.84). Further studies are welcome to validate the lsERBI.

The Early Rehabilitation Barthel Index (ERBI)

An extended version of the Barthel index, the so-called "Early Rehabilitation Barthel Index", or ERBI, is widely used in German early neurological rehabilitation centres and even was used in defining early rehabilitation procedures in the German DRG system. It contains highly relevant items like mechanical ventilation, tracheostomy, or dysphagia. This study presents an English version of the ERBI and examines its validity and reliability. Two samples of early neurological rehabilitation patients have been analyzed. In one sample (n=1,669), measures of morbidity and length of stay (LOS) have been compared between certain ERBI categories. In a second sample (n=273), inter-rater reliability (nurses vs. physicians) has been examined. Patients with low ERBI had a significantly longer LOS than those with high ERBI values (p<0.001). Further, parameters of morbidity (patient clinical complexity level, number of co-diagnoses) were significantly higher in a low ERBI subgroup. Inter-rater reliability was r=0.849 (p<0.001). The findings suggest that the ERBI is a reliable and valid scale to assess early neurological rehabilitation patients.