Stroke, Vol 22, 1242-1244, Copyright © 1991 by American Heart Association
CD Wolfe, NA Taub, EJ Woodrow and PG Burney
BACKGROUND AND PURPOSE: The purpose of the study is to compare the
reliability of the Barthel activities of daily living score, which assesses
disability, with the Rankin scale, which assesses handicap, and to
determine their mutual agreement. METHODS: Fifty patients with stroke of
varying severity were identified by a community-based stroke register and
interviewed by two of three research nurses on two occasions that were 2-3
weeks apart. RESULTS: There was no evidence of a systematic difference
between the first and second measurements. Repeatability was assessed using
a kappa statistic with quadratic disagreement weights (kappa w) to take
account of extreme differences. This measure was very good for both Barthel
(kappa w = 0.98) and Rankin (kappa w = 0.95) scales. There was also
excellent agreement between raters for the Barthel scale (kappa w greater
than or equal to 0.88), but some indication of disagreement (kappa w =
0.75) between raters for the Rankin scale. Analysis of variance confirmed
these findings. A conversion from the Barthel to the Rankin scale can be
derived by assigning the most common Rankin score for the subjects with a
given Barthel score, producing a kappa w of 0.91 for agreement.
CONCLUSIONS: The Barthel scale is a more reliable and less subjective scale
for assessing disability, from which a Rankin handicap score can then be
derived to enable those managing stroke patients to assess aspects of
handicap as well as disability.
ARTICLES
Assessment of scales of disability and handicap for stroke patients
Division of Community Health, UMDS (St. Thomas' Campus), London, England.
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