(Stroke. 1999;30:1538-1541.)
© 1999 American Heart Association, Inc.
Original Contributions |
Use of the Barthel Index and Modified Rankin Scale in Acute Stroke Trials
From the Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, Netherlands.
Correspondence to Professor J. De Keyser, Department of Neurology, Academisch Ziekenhuis Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands. E-mail j.h.a.de.keyser{at}neuro.azg.nl
Background and Purpose—The Barthel Index (BI) and the Modified Rankin Scale (MRS) are commonly used scales that measure disability or dependence in activities of daily living in stroke victims. The objective of this study was to investigate how these scales were used and interpreted in acute stroke trials.
Methods—We identified from MEDLINE the major efficacy trials with neuroprotective drugs, thrombolytic drugs, and anticoagulants in acute ischemic stroke published between January 1995 and December 1998. We selected those trials that used the BI and/or MRS as outcome parameters.
Results—Fifteen trials fulfilling the inclusion criteria
were identified. The BI was used in 13 and the MRS in 8. In 4 trials
mean and median scores of the BI were used, and in 1 trial median
scores of the MRS were compared. Primary end points included the BI in
7, the MRS in 6, and both the BI and MRS in 3. With regard to the BI, a
variety of sum scores between 50 and 95 were used as cutoff scores to
define favorable outcome. Favorable outcome on the MRS was defined as
either 
1 or 2.
Conclusions—Among the efficacy trials in acute stroke, we found remarkable differences in the choice of primary end points and in the definition of favorable outcome on both the BI and MRS. This lack of consensus strongly hinders the design, interpretation, and comparison of acute stroke trials. In general, it may be easier to define poor outcome instead of favorable outcome. Poor outcome could be defined if any of the following end points are reached: death, institutionalization due to stroke, MRS >3, or BI <60.
Key Words: disability evaluation • outcome • stroke trials
This article has been cited by other articles:
 |
|
 |
|
  A. W. Asimos, W. D. Rosamond, A. M. Johnson, M. F. Price, K. M. Rose, C. V. Murphy, C. H. Tegeler, and A. Felix Early Diffusion Weighted MRI as a Negative Predictor for Disabling Stroke After ABCD2 Score Risk Categorization in Transient Ischemic Attack Patients Stroke, October 1, 2009; 40(10): 3252 - 3257. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N L Cabral, A R R Goncalves, A L Longo, C H C Moro, G Costa, C H Amaral, L A M Fonseca, and J Eluf-Neto Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study J. Neurol. Neurosurg. Psychiatry, July 1, 2009; 80(7): 755 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Alexander, S. Poloyac, L. Hoffman, M. Gallek, Dianxu Ren, J. Balzer, A. Kassam, and Y. Conley Endothelial Nitric Oxide Synthase Tagging Single Nucleotide Polymorphisms and Recovery From Aneurysmal Subarachnoid Hemorrhage Biol Res Nurs, July 1, 2009; 11(1): 42 - 52. [Abstract] [PDF]
|
|
|
|
|
|
M. C. Christensen, S. Mayer, and J.-M. Ferran Quality of Life After Intracerebral Hemorrhage: Results of the Factor Seven for Acute Hemorrhagic Stroke (FAST) Trial Stroke, May 1, 2009; 40(5): 1677 - 1682. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Saver and J. Gornbein Treatment effects for which shift or binary analyses are advantageous in acute stroke trials Neurology, April 14, 2009; 72(15): 1310 - 1315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Audebert, K. Schultes, V. Tietz, P. U. Heuschmann, U. Bogdahn, R. L. Haberl, J. Schenkel, and Writing Committee for the Telemedical Project for Long-Term Effects of Specialized Stroke Care With Telemedicine Support in Community Hospitals on Behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS) Stroke, March 1, 2009; 40(3): 902 - 908. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Gallek, Y. P. Conley, P. R. Sherwood, M. B. Horowitz, A. Kassam, and S. A. Alexander APOE Genotype and Functional Outcome Following Aneurysmal Subarachnoid Hemorrhage Biol Res Nurs, January 1, 2009; 10(3): 205 - 212. [Abstract] [PDF]
|
|
|
|
|
|
T. J. Quinn, G. Ray, S. Atula, M. R. Walters, J. Dawson, and K. R. Lees Deriving Modified Rankin Scores From Medical Case-Records Stroke, December 1, 2008; 39(12): 3421 - 3423. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Salvarani, R. D. Brown Jr, K. T. Calamia, T. J. H. Christianson, J. Huston III, J. F. Meschia, C. Giannini, D. V. Miller, and G. G. Hunder Primary central nervous system vasculitis: comparison of patients with and without cerebral amyloid angiopathy Rheumatology, November 1, 2008; 47(11): 1671 - 1677. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Salvarani, R. D. Brown Jr, K. T. Calamia, T.J.H. Christianson, J. Huston III, J. F. Meschia, C. Giannini, D. V. Miller, and G. G. Hunder Primary CNS vasculitis with spinal cord involvement Neurology, June 10, 2008; 70(24_Part_2): 2394 - 2400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Dahl, T. Askim, R. Stock, E. Langorgen, S. Lydersen, and B. Indredavik Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial Clinical Rehabilitation, May 1, 2008; 22(5): 436 - 447. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Legg, A. Drummond, J. Leonardi-Bee, J R F Gladman, S. Corr, M. Donkervoort, J. Edmans, L. Gilbertson, L. Jongbloed, P. Logan, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials BMJ, November 3, 2007; 335(7626): 922 - 922. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Saver Hemorrhage After Thrombolytic Therapy for Stroke: The Clinically Relevant Number Needed to Harm Stroke, August 1, 2007; 38(8): 2279 - 2283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Banks and C. A. Marotta Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials: A Literature Review and Synthesis Stroke, March 1, 2007; 38(3): 1091 - 1096. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Deplanque, I. Masse, C. Lefebvre, C. Libersa, D. Leys, and R. Bordet Prior TIA, lipid-lowering drug use, and physical activity decrease ischemic stroke severity Neurology, October 24, 2006; 67(8): 1403 - 1410. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Parker, D. Bechinger-English, C. Jagger, N. Spiers, and J. Lindesay Factors affecting completion of the SF-36 in older people Age Ageing, July 1, 2006; 35(4): 376 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Hand, J. M. Wardlaw, C. S. Rivers, P. A. Armitage, M. E. Bastin, R. I. Lindley, and M. S. Dennis MR diffusion-weighted imaging and outcome prediction after ischemic stroke Neurology, April 25, 2006; 66(8): 1159 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Song, C. Jerosch-Herold, R. Holland, M. d. L. Drachler, K. Mares, and I. Harvey Statistical methods for analysing Barthel scores in trials of poststroke interventions: a review and computer simulations Clinical Rehabilitation, April 1, 2006; 20(4): 347 - 356. [Abstract] [PDF]
|
|
|
|
|
|
S. W. Yong, O. Y. Bang, P. H. Lee, and W. Y. Li Internal and Cortical Border-Zone Infarction: Clinical and Diffusion-Weighted Imaging Features Stroke, March 1, 2006; 37(3): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Marcel, D. Leys, F. Mounier-Vehier, D. Bertheloot, E. Lartigau, J. P. Pruvo, M. Al-Koussa, D. Chevalier, and H. Henon Clinical outcome in patients with high-grade internal carotid artery stenosis after irradiation Neurology, September 27, 2005; 65(6): 959 - 961. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Uyttenboogaart, R. E. Stewart, P. C.A.J. Vroomen, J. De Keyser, and G.-J. Luijckx Optimizing Cutoff Scores for the Barthel Index and the Modified Rankin Scale for Defining Outcome in Acute Stroke Trials Stroke, September 1, 2005; 36(9): 1984 - 1987. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W. Schaefer, T. A. G. M. Huisman, A. G. Sorensen, R. G. Gonzalez, and L. H. Schwamm Diffusion-weighted MR Imaging in Closed Head Injury: High Correlation with Initial Glasgow Coma Scale Score and Score on Modified Rankin Scale at Discharge Radiology, October 1, 2004; 233(1): 58 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Davis, A. A. Wong, P. J. Schluter, R. D. Henderson, J. D. O'Sullivan, and S. J. Read Impact of Premorbid Undernutrition on Outcome in Stroke Patients Stroke, August 1, 2004; 35(8): 1930 - 1934. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Dziedzic, A. Slowik, and A. Szczudlik Serum Albumin Level as a Predictor of Ischemic Stroke Outcome Stroke, June 1, 2004; 35(6): e156 - e158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Marti-Fabregas, M. Gomis, A. Arboix, A. Aleu, J. Pagonabarraga, R. Belvis, D. Cocho, J. Roquer, A. Rodriguez, M. D. Garcia, et al. Favorable Outcome of Ischemic Stroke in Patients Pretreated with Statins Stroke, May 1, 2004; 35(5): 1117 - 1121. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Y. Bang, S. Y. Joo, P. H. Lee, U. S. Joo, J. H. Lee, I. S. Joo, and K. Huh The Course of Patients With Lacunar Infarcts and a Parent Arterial Lesion: Similarities to Large Artery vs Small Artery Disease Arch Neurol, April 1, 2004; 61(4): 514 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Askim, G Rohweder, S Lydersen, and B Indredavik Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial Clinical Rehabilitation, March 1, 2004; 18(3): 238 - 248. [Abstract] [PDF]
|
|
|
|
|
|
R. Gupta, E. S. Connolly, S. Mayer, and M. S.V. Elkind Hemicraniectomy for Massive Middle Cerebral Artery Territory Infarction: A Systematic Review Stroke, February 1, 2004; 35(2): 539 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. B. Young, K. R. Lees, and C. J. Weir Strengthening Acute Stroke Trials Through Optimal Use of Disability End Points Stroke, November 1, 2003; 34(11): 2676 - 2680. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cavallini, G. Micieli, S. Marcheselli, and S. Quaglini Role of Monitoring in Management of Acute Ischemic Stroke Patients Stroke, November 1, 2003; 34(11): 2599 - 2603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
PROGRESS Effects of a Perindopril-Based Blood Pressure-Lowering Regimen on Disability and Dependency in 6105 Patients With Cerebrovascular Disease: A Randomized Controlled Trial Stroke, October 1, 2003; 34(10): 2333 - 2338. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-M. Lai, S. Perera, P. W. Duncan, and R. Bode Physical and Social Functioning After Stroke: Comparison of the Stroke Impact Scale and Short Form-36 Stroke, February 1, 2003; 34(2): 488 - 493. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Sulter, J. W. Elting, M. Langedijk, N. M. Maurits, and J. De Keyser Admitting Acute Ischemic Stroke Patients to a Stroke Care Monitoring Unit Versus a Conventional Stroke Unit: A Randomized Pilot Study Stroke, January 1, 2003; 34(1): 101 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kurth, J. M. Gaziano, K. Berger, C. S. Kase, K. M. Rexrode, N. R. Cook, J. E. Buring, and J. E. Manson Body Mass Index and the Risk of Stroke in Men Arch Intern Med, December 9, 2002; 162(22): 2557 - 2562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Nabavi, S. P. Kloska, E.-M. Nam, M. Freund, C. G. Gaus, E. Klotz, W. Heindel, and E. B. Ringelstein MOSAIC: Multimodal Stroke Assessment Using Computed Tomography: Novel Diagnostic Approach for the Prediction of Infarction Size and Clinical Outcome Stroke, December 1, 2002; 33(12): 2819 - 2826. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Szatmary, V. Biousse, and N. J. Newman Can Swedish Interactive Thresholding Algorithm Fast Perimetry Be Used as an Alternative to Goldmann Perimetry in Neuro-ophthalmic Practice? Arch Ophthalmol, September 1, 2002; 120(9): 1162 - 1173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Weimar, T. Kurth, K. Kraywinkel, M. Wagner, O. Busse, R. L. Haberl, and H.-C. Diener Assessment of Functioning and Disability After Ischemic Stroke Stroke, August 1, 2002; 33(8): 2053 - 2059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Gladstone, S. E. Black, and A. M. Hakim Toward Wisdom From Failure: Lessons From Neuroprotective Stroke Trials and New Therapeutic Directions Stroke, August 1, 2002; 33(8): 2123 - 2136. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Leys, L. Bandu, H. Henon, C. Lucas, F. Mounier-Vehier, P. Rondepierre, and O. Godefroy Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke Neurology, July 9, 2002; 59(1): 26 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, J. I. Suarez, C. Santillan, J. L. Sunshine, R. W. Tarr, V. H. Paras, W. R. Selman, D. M.D. Landis, and D. D. Tong Response to Intra-Arterial and Combined Intravenous and Intra-Arterial Thrombolytic Therapy in Patients With Distal Internal Carotid Artery Occlusion * Editorial Comment Stroke, July 1, 2002; 33(7): 1821 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-M. Lai, S. Studenski, P. W. Duncan, and S. Perera Persisting Consequences of Stroke Measured by the Stroke Impact Scale Stroke, July 1, 2002; 33(7): 1840 - 1844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Castellanos, J. Castillo, M. M. Garcia, R. Leira, J. Serena, A. Chamorro, and A. Davalos Inflammation-Mediated Damage in Progressing Lacunar Infarctions: A Potential Therapeutic Target Stroke, April 1, 2002; 33(4): 982 - 987. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Iranzo, J. Santamaria, J. Berenguer, M. Sanchez, and A. Chamorro Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction Neurology, March 26, 2002; 58(6): 911 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Celani, T. A. Cantisani, E. Righetti, L. Spizzichino, and S. Ricci Different Measures for Assessing Stroke Outcome: An Analysis From the International Stroke Trial in Italy Stroke, January 1, 2002; 33(1): 218 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Kuipers-Upmeijer, A E J de Jager, J M Hew, J W Snoek, and T W van Weerden Primary lateral sclerosis: clinical, neurophysiological, and magnetic resonance findings J. Neurol. Neurosurg. Psychiatry, November 1, 2001; 71(5): 615 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sacco, J. T. DeRosa, E. C. Haley Jr, B. Levin, P. Ordronneau, S. J. Phillips, T. Rundek, R. G. Snipes, J. L. P. Thompson, and for the GAIN Americas Investigators Glycine Antagonist in Neuroprotection for Patients With Acute Stroke: GAIN Americas: A Randomized Controlled Trial JAMA, April 4, 2001; 285(13): 1719 - 1728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Briggs, R. A. Felberg, M. D. Malkoff, P. Bratina, and J. C. Grotta Should Mild or Moderate Stroke Patients Be Admitted to an Intensive Care Unit? Stroke, April 1, 2001; 32(4): 871 - 876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. McKevitt, R. Dundas, and C. Wolfe Two Simple Questions to Assess Outcome After Stroke : A European Study Stroke, March 1, 2001; 32(3): 681 - 686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Bereczki, M. Liu, G. F. d. Prado, and I. Fekete Cochrane Report : A Systematic Review of Mannitol Therapy for Acute Ischemic Stroke and Cerebral Parenchymal Hemorrhage Stroke, November 1, 2000; 31(11): 2719 - 2722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Ahmed, P. Nasman, and N. G. Wahlgren Effect of Intravenous Nimodipine on Blood Pressure and Outcome After Acute Stroke Stroke, June 1, 2000; 31(6): 1250 - 1255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Duncan, H. S. Jorgensen, and D. T. Wade Outcome Measures in Acute Stroke Trials : A Systematic Review and Some Recommendations to Improve Practice Stroke, June 1, 2000; 31(6): 1429 - 1438. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Castillo, R. Rama, and A. Davalos Nitric Oxide-Related Brain Damage in Acute Ischemic Stroke Stroke, April 1, 2000; 31(4): 852 - 857. [Abstract] [Full Text] [PDF]
|
|