U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
NeuroRehabilitation. 2012;30(4):315-22. doi: 10.3233/NRE-2012-0761.
The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most common clinimetrical instruments for measuring disability after stroke. This study investigated the relationship between the BI and the mRS at multiple time points after stroke. The BI, which is a widely used instrument for longitudinal follow-up post-stroke, was used as reference to determine the effect of time on the sensitivity of the mRS in differentiating functional recovery.
Ninety-two patients with first stroke and hemispheric brain lesion were evaluated using the BI and mRS at 10 days, 3 and 6 months. The Kruskal-Wallis test was applied to examine median differences in BI among the mRS levels at 10 days, 3 and 6 months with Dunn's correction for multigroup comparison. The Mann and Whitney test was used to compare median differences in BI scores between two aggregations of mRS grades (mRS=0-2, mRS=3-5) at the same time periods after stroke.
BI score distribution amongst mRS grades overlapped at 10 days, differentiating only between extreme grades (no disability vs severe disability). At 3 months, independent patients with slight disability could be distinguished from dependent patients with marked disability. At 6 months, grade 2 and 3 overlapped no more, differentiating independence (class 0-2) from dependence (class 3-5). The largest transition to an independent functional status occurred from grade 4, at 3 months.
Maximum sensitivity of mRS in differentiating functional recovery is reached at six months post-stroke.
改良 Rankin 量表（mRS）和 Barthel 指数（BI）是衡量卒中后残疾程度最常用的临床计量工具。本研究旨在探讨卒中后多个时间点 BI 与 mRS 之间的关系。BI 是一种广泛用于卒中后纵向随访的工具，本研究将其作为参考，以确定时间对 mRS 区分功能恢复的敏感性的影响。
92 例首发脑卒中且病变位于大脑半球的患者分别在 10 天、3 个月和 6 个月时接受 BI 和 mRS 评估。Kruskal-Wallis 检验用于检验 BI 在 mRS 水平之间的中位数差异，在 10 天、3 个月和 6 个月时采用 Dunn 校正进行多组比较。Mann-Whitney 检验用于比较卒中后同一时间段内 mRS 两个等级分组（mRS=0-2，mRS=3-5）的 BI 评分中位数差异。
BI 评分在 mRS 分级中分布存在重叠，仅在极端分级（无残疾与严重残疾）之间存在差异。在 3 个月时，能够区分轻度残疾的独立患者和重度残疾的依赖患者。在 6 个月时，2 级和 3 级不再重叠，能够区分独立（0-2 级）和依赖（3-5 级）状态。从 4 级到 3 个月时，向独立功能状态的转变最大。
mRS 在区分功能恢复方面的最大敏感性在卒中后 6 个月时达到。
