Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients
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Barthel index
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Aim:To evaluate the clinical curative effect and safety of ganglioside GM1 in treatment of acute cerebral infarctions. Methods:96 patients from the onset within 72 h were randomly divided into two groups:the ganglioside GM1 treated group and control group. The Chinese Stroke Scale (CSS),Barthel Index (BI) ,and Rankin Scale were used to evaluate the recovery of neurological functions.Results:The obvious effective rate of the therapy group was 52.08%,response rate was 31.25%. Whereas,these data of the control group were 25.00% and 52.08%,respectively.The Barthel Index significantly changed in treatment group(P0.05) . Rankin Scale at 3 months after initiation significantly decreased in treatment group. Conclusion:Ganglioside GM1 is effective and relative safety in treatment of acute cerebral infarctions.
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Objectives To observe the efficacy of early rehabilitation in treating acute hemiplegic stroke.Methods 126 cases of hemiparalysis patients with acute stroke were randomly divided into two groups.62 patients in the treated group were given conventional treatment and early rehabilitation treatment with Bobath technique for 30 day as a course. 64 patients in the control group were given only conventional treatment.The evaluation points included clinical neurological deficitis scate of stroke.Barthel index and the total effective rate at the begin and the end(30 day) of the course.Results The results revealed that the clinical neurological defects in the treated group was much lower than the control group(P0.01).The Barthel index increased markedly,compared to the control group(P0.01).The total effective rate was 95% in the treated group,while 84% in the control group(χ 2=3.96,P0.05).Conclusions Early rehabilitation is very effective for the functional recovery after acute hemiplegic stroke.It can markedly decrease disabilities and improve daily activities.
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There is little agreement on how to assess outcome in acute stroke trials. Cutoff scores for the Barthel Index (BI) and modified Rankin Scale (mRS) are frequently arbitrarily chosen to dichotomize favorable and unfavorable outcome. We investigated sensitivity and specificity of BI cutoff scores in relation to the mRS to obtain the optimal corresponding BI and mRS scores.BI and mRS scores were collected from 1034 ischemic stroke patients. Sensitivity and specificity were calculated for BI cutoff scores from 45 to 100 in mRS score 1, 2, and 3 and were plotted in receiver operator characteristic (ROC) curves.The cutoff scores for the BI with the highest sum of sensitivity and specificity were 95 (sensitivity 85.6%; specificity 91.7%), 90 (sensitivity 90.7%; specificity 88.1%), and 75 (sensitivity 95.7%; specificity, 88.5%) for, respectively, mRS 1, 2, and 3. The area under the ROC curve was 0.933 in mRS 1, 0.960 in mRS 2, and 0.979 in mRS 3.The optimal cutoff scores for the BI were 95 for mRS 1, 90 for mRS 2, and 75 for mRS 3. For future acute stroke trials that assess stroke outcome with the BI and mRS, we recommend the use of these BI cutoff score(s) with the corresponding mRS cutoff score(s), to ensure the use of consistent and uniform end points.
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Barthel index
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The Barthel Index (BI) cannot be used to measure initial stroke severity or by extension, to stratify patients by severity in acute stroke trials because most patients are bedbound in the first few hours after stroke, either by their deficit or by medical directive. Our objectives were to clarify the threshold of acute BI for use in the prediction of subsequent independence in activities of daily living (ADL) and to assist in the definition of acute stroke rehabilitation goals. Subjects comprised 78 patients out of 191 inpatients admitted with acute stroke at our hospital during 2006-2007. The BI ADL score was divided into 2 ranges (BI>=60 and <=40), in a process similar to previous studies. During the acute period (from onset to approximately 3 weeks), all patients with a BI>=40 could improve their ADL in 6 months. Patients with a BI<=40 exhibited two ADL recovery outcomes (improved and no change) at 6 months. We also found that the skill level of basic activities related to standing was significant indicator of BI improvement (P<0.001). BI scores determined at approximately 3 weeks were reliable predictors of ADL disabilities at 6 months. J. Med. Invest. 57: 81-88, February, 2010
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Introduction: Both the American Heart and American Stroke Associations recommend pre-notification of potential stroke patients to receiving facilities. Although Emergency Medical Services (EMS) may identify stroke symptoms in the field, initiation of the stroke code process is often postponed until after the patient arrives in the Emergency Department (ED). This could lead to unnecessary delays in assessment and intervention during an acute stroke. Hypothesis: We hypothesized that initiating a stroke code based on advanced notification of stroke symptoms via EMS and a Stroke Code Pit Stop (SCPS) would lead to decreased time of assessment, diagnosticssitics and IV tPA initiation. Methods: A pre- and post-intervention study of 733 patients presenting to 2 EDs in a 5 campus hospital system. Both EDs initiated a SCPS, with pre-notification of stroke symptoms via EMS and stroke code activation prior to patient arrival. Data were reviewed from January 2013-April 2014, comparing code stroke metrics pre- and post...
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ObjectiveTo study the effct of the early rehabilitation of acute stroke with acupunction added to rehabilitational training.Methods120 patients with acute stroke were divided into 2 growps with 60 cases each:the acupunction growp,in which the patients were acepted acupuncture added to rehabilitational training,and the control growp,in which the patients were acepted the rehabilitational training only.All the patients were evaluated with Clinical Nervous Functional Deficiency(CNFD),Fugl-Meyer Assessment(FMA) and Modified Barthel Index(MBI).Results The scales of CNFD,FMAanal Deficiency (CNFD),Fugl-Meyer Assess me that of the control growp.The rate of cure and significantly in the acupunction growp was 75%,while that of the control growp was 41.7%(p0.01).Conclusions Acupunction compared with the rehabilitational training is effective on the with stroke.
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The aim of the study was to assess early poststroke prognostic factors in patients admitted for postacute phase rehabilitation.A 1-yr multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for postacute rehabilitation. Clinical data were collected in the stroke or acute care units (acute phase), then in rehabilitation units (postacute phase), and, subsequently, after a 6-mo poststroke period (follow-up). Clinical outcome measures were represented using the Barthel Index and the modified Rankin Scale. Univariate and multivariate analyses were performed to identify the most important prognostic index.Modified Rankin Scale score, minor neurologic impairment, and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to Barthel Index (power of prediction = 37%). Similarly, age, premorbid modified Rankin Scale score, and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the modified Rankin Scale (power of prediction = 48%). Barthel Index at admission and certain co-morbidities were also significant prognostic factors correlated with a better outcome.According to the Barthel Index and modified Rankin Scale, early mobilization is an early predictor of favorable outcome.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Incorporate prognostic factors of good clinical outcomes after stroke in developing treatment plans for patients admitted to rehabilitation; (2) Identify acute phase indicators associated with favorable 6-mo outcome after stroke; and (3) Recognize the cut-off for early mobilization linked to better outcome in stroke survivors admitted to rehabilitation.Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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