A COMPARISON OF THE BARTHEL-INDEX AND THE OPCS-DISABILITY-INSTRUMENT USED TO MEASURE OUTCOME AFTER ACUTE STROKE

The Barthel Index has been widely adopted as a measure of-disability. The Office of Population Censuses and Surveys (OPCS) disability instru ment was developed to provide a comprehensive measure of disability fo r use in the 1985 survey of disability among adults. Both measures wer e used on 150 patients surviving 1 year from a consecutive cohort of 2 46 admissions to hospital with acute stroke. The Barthel Index when su mmed across categories (as is commonly done), correlated reasonably we ll with the OPCS disability instrument [-0.73 (p < 0.001) 95% CI 0.64 to 0.80] despite its reliance on arbitrary weights and the omission of categories for communication, vision, hearing and intellectual disabi lity. The broader scope of the OPCS instrument explained most of the f loor and ceiling effects seen with the Barthel Index. The Barthel Inde x continues to have a useful role in stroke rehabilitation when used a s a checklist for rehabilitation goals set by clinicians, as a predict or of long-term outcome and as an overall measure of disability or act ivities of daily living in descriptive studies, randomized controlled trials and audit. However, its floor and ceiling effects may lead to a n underestimation of patients' and carers' problems in up to a third o f patients. The OPCS instrument may prove to be a more useful outcome measure in randomized controlled trials and audits by virtue of its co mprehensive nature.