Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey.

ABSTRACT

The aim of this study was to adapt the modified Barthel Index for Turkey and to determine its reliability and validity. After the translation procedure, 50 stroke patients and 50 spinal cord injury patients, undergoing inpatient rehabilitation were assessed by the newly adapted index at admission and discharge. Reliability was tested using internal consistency, inter-rater reliability and the intra-class correlation coefficient. Construct validity was assessed by association with impairments (Brunnstrom motor stages in stroke, American Spinal Injury Association motor/sensory scores and impairment scale in spinal cord injury) and by Rasch analysis. Internal consistency was good at 0.93 for stroke, and 0.88 for spinal cord injury. The level of agreement between two raters was sufficient with Kappa levels of above 0.5 for spinal cord injury and above 0.6 for stroke. Intra-class correlation coefficients were 0.99 and 0.77 for stroke and spinal cord injury, respectively. The newly adapted index showed expected associations with the impairment scales, confirming its construct validity. However, Rasch analysis showed that bladder and bowel items compromise unidimensionality. In conclusion, adaptation of the modified Barthel Index has been successful and it can be used in Turkey as long as its limitations are recognized.