Uyttenboogaart M, Luijckx G-J, Vroomen P C A J, Stewart R E, De Keyser J
Department of Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
J Neurol. 2007 Aug;254(8):1113-7. doi: 10.1007/s00415-007-0646-0. Epub 2007 Aug 6.
The effectiveness of therapeutic interventions in acute stroke trials is traditionally measured with the modified Rankin scale (mRs) and the Barthel index (BI). The mRs is a global disability scale divided into six steps from total independence to total dependence. The BI assesses ten basal activities of daily living, of which eight assess level of dependence (bathing, grooming, using stairs, dressing, feeding, toilet use, transfers and walking). The aim of this study was to investigate the relationship between the mRs and the total scores and item-scores of the BI.
During a period of 3 months mRs and BI scores were collected from two multicentre randomised, placebo-controlled trials with lubeluzole (515 and 519 patients). In each patient we compared the mRs grades with the total BI score and the scores on the ten subitems.
For both trials there was extensive overlap of BI scores between mRs grades and a wide range in BI scores among patients with mRs grades 3 and 4. We also found discrepancies between the BI item-scores and mRs grades. About 40% of patients with mRs grades 1 (able to carry out all usual activities) and 2 (able to look after own affairs without assistance) were not independent on at least one activity of the BI. In both studies, about 30% of the patients needed help or supervision for walking, although they were classified as mRs 3 (requiring some help but able to walk without assistance).
Investigators in stroke trials use the mRs as a subjective global disability scale, and they do not strictly take into account limitations in performing specific basal activities of daily living, as assessed by the BI, to assign mRs grades.
急性中风试验中治疗干预的有效性传统上是用改良Rankin量表（mRs）和巴氏指数（BI）来衡量的。mRs是一个整体残疾量表，分为从完全独立到完全依赖的六个等级。BI评估十项日常生活基本活动，其中八项评估依赖程度（洗澡、修饰、上下楼梯、穿衣、进食、使用厕所、转移和行走）。本研究的目的是调查mRs与BI总分及各项目得分之间的关系。
在3个月的时间里，从两项使用鲁贝唑的多中心随机、安慰剂对照试验（分别有515名和519名患者）中收集mRs和BI评分。我们比较了每名患者的mRs等级与BI总分及十个子项目的得分。
在两项试验中，mRs等级之间的BI评分有广泛重叠，mRs 3级和4级患者的BI评分范围也很广。我们还发现BI项目得分与mRs等级之间存在差异。约40%的mRs 1级（能够进行所有日常活动）和2级（能够在无帮助的情况下料理自己的事务）患者在BI的至少一项活动中不具备独立性。在两项研究中，约30%的患者虽然被归类为mRs 3级（需要一些帮助但能够独立行走），但行走时仍需要帮助或监督。
中风试验的研究者将mRs用作主观的整体残疾量表，在确定mRs等级时，并未严格考虑BI所评估的特定日常生活基本活动执行方面的局限性。
