RESPONSIVENESS OF THE REHABILITATION ACTIVITIES PROFILE AND THE BARTHEL INDEX

The goal of this study was to compare the responsiveness for clinicall y meaningful change over time of a newly designed functional status sc ale, the Rehabilitation Activities Profile (RAP), with the more freque ntly used Barthel Index (BI). Four techniques for the quantification o f responsiveness were utilized: effect sizes, p-values, t-statistics a nd ROC curves. The patient's return home was chosen as external criter ion, An inception cohort of stroke patients was followed during 26 wee ks. All patients still hospitalized on the 14th day after stroke were included. The functional assessments took place at 2, 3, 4, 8, 12, and 26 weeks after stroke. The patients were visited at the hospital, hom e, nursing home, or rehabilitation center. Of the 125 patients include d in the study, 18 patients died during the observation period, 2 pati ents were lost to follow-up, and 1 patient refused to cooperate after 12 weeks. After 26 weeks, 104 patients remained for analysis, Three ti me periods were discerned: 2 to 12 weeks (early response), 12 to 26 we eks (late response), and 2 to 26 weeks after stroke (overall response) . The effect sizes of the RAP were consistently higher on all three ti me periods than those of the BI. The p-value of the overall response m ean change score of the RAP appeared to discriminate between patients returning home and those not returning home, whereas the BI failed on this point (p = 0.004 vs. 0.496). Using t-statistics, the RAP showed a higher efficiency in expressing change on all time periods (relative efficiency = 1.42, 1.77, and 1.43, respectively). The receiver operati ng characteristic surface area of the RAP score was higher than the ar ea of the BI score (0.74 and 0.59, respectively for the early response period). In conclusion, all results seem to indicate that the RAP is more responsive than the BI when returning home is chosen as an extern al criterion.