J Clin Epidemiol. 2002 Sep;55(9):922-8.

Comparison of the responsiveness of the Barthel Index and the

motor component of the Functional Independence Measure in
stroke: the impact of using different methods for measuring
responsiveness.

Wallace D1, Duncan PW, Lai SM.

Author information

Abstract

Two disability measures frequently used to assess the effects of interventions on stroke recovery
are the Barthel Index (BI) and the motor component of the Functional Independence Measure
(FIM Instrument). This study compared multiple measures of responsiveness of these
instruments to stroke recovery between 1 and 3 months. Data on a 1- to 3-month change in the
Instruments were obtained for 372 subjects who improved or maintained function on the
modified Rankin Scale (MRS), using a subset of 459 eligible patients with confirmed stroke as
defined by WHO criteria recruited from 12 participating hospitals in the Greater Kansas City area.
Subjects were excluded because of death, early withdrawal from the study, missing MRS, or
outcome data (57) decline on MRS (26), or inability to improve on MRS (4). Techniques used to
assess responsiveness were: area under the ROC curve, Guyatt's effect size, paired t-statistics,
standardized response mean, Kazis effect size, and mixed model adjusted t-statistic. The FIM
Instrument and BI show little difference in responsiveness to change. The different
responsiveness measures are generally consistent with this conclusion, with no measure clearly
superior to the others. Large differences in the responsiveness measures were obtained within
an instrument depending on the populations used (changers only or both changers and those
who maintained function). Results also suggest responsiveness assessments are likely to be
affected by time frame and phase of rehabilitation over which the responsiveness of a measure
is determined.

Int J Rehabil Res. 2005 Jun;28(2):135-9.

A comparison of the Barthel Index and the Functional

Independence Measure as outcome measures in stroke
rehabilitation: patterns of disability scale usage in clinical trials.
Sangha H1, Lipson D, Foley N, Salter K, Bhogal S, Pohani G,
Teasell RW.
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Abstract

In order to compare the frequency and patterns of use of the Barthel Index (BI) and Functional
Independence Measure (FIM) in stroke rehabilitation trials, all randomized controlled trials
(RCTs) of stroke rehabilitation published between 1968 and 2002 were identified and reviewed
to determine the frequency with which the BI and FIM measures were used relative to other
measures of disability. The date and location of each study citing either the FIM or the BI were
also recorded. Studies were assigned ratings of methodological quality based on the
physiotherapy evidence database (PEDro) scoring system. Comparisons of the age, frequency
and continents of origin and methodological quality of the studies were explored. Results
indicate that the BI and FIM were the most common measures of disability used in RCTs
examining stroke rehabilitation. However, the BI was used more often than the FIM (n=86,
P<0.001) and was cited in trials of superior quality (P=0.005). Studies from North America were
more likely to use the FIM compared with European studies (n=24, P<0.001). Publications citing
the BI were significantly more recent when originating in Europe as opposed to North America
(P=0.023). These results provide insight into current patterns of scale use in stroke rehabilitation
research.