LONGER TERM QUALITY-OF-LIFE AND OUTCOME IN STROKE PATIENTS - IS THE BARTHEL INDEX ALONE AN ADEQUATE MEASURE OF OUTCOME

Objectives-To consider whether the Barthel Index alone provides suffic ient information about the long term outcome of stroke. Design-Cross s ectional follow up study with a structured interview questionnaire and measures of impairment, disability, handicap, and general health. The scales used were the hospital anxiety and depression scale, mini ment al state examination, Barthel index, modified Rankin scale, London han dicap scale, Frenchay activities index, SF36, Nottingham health profil e, life satisfaction index, and the caregiver strain index. Setting-So uth east London. Subjects-People, and their identified carers, residen t in south east London in 1989-90 when they had their first in a lifet ime stroke aged under 75 years. Interventions-Observational study. Mai n outcome measures-Comparison and correlation of the individual Barthe l index scores with the scares on other outcome measures. Results-One hundred and twenty three (42%) people were known to be alive, of whom 106 (86%) were interviewed. The median age was 71 years (range 34-79). The mean interval between the stroke and follow up was 4.9 years. The rank correlation coefficients between the Barthel and the different d imensions of the SF36 ranged from r=0.217 (with the role emotional dim ension) to r=0.810 (with the physical functioning dimension); with the Nottingham health profile the range was r=-0.189 (with the sleep dime nsion, NS) to r=-0.840 (with the physical mobility dimension); with th e hospital and anxiety scale depression component the coefficient was r=-0.563, with the life satisfaction index r=0.361, with the London ha ndicap scale r=0.726 and with the Frenchay activities index r=0.826.Co nclusions-The place of the Barthel index as the standard outcome measu re for populations of stroke patients is still justified for long term follow up, and may be a proxy for different outcome measures intended for the assessment of other domains.