Krupp Sonja, Kasper Jennifer, Gollmer Christina, Balck Friedrich, Kasten Meike, Willkomm Martin
Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland.
Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
Z Gerontol Geriatr. 2025 Mar 31. doi: 10.1007/s00391-025-02436-2.
The Barthel Index is the most commonly used instrument for assessing basic self-care ability; however, it only records impairments first at the stage of needing personal support.
Based on the long version of the Hamburg Classification Manual (HEMB-L), the Barthel plus (Bplus) was developed in consultation with specialist nursing personnel as an operationalization that also depicts compensated impairments via point-neutral subscaling. The article presents the instrument and its quality characteristics.
For patients in acute geriatric care the Bplus was employed twice at an interval of more than 1 week and audio recordings were made. The Bplus was assessed by telephone 1, 12, 24 and 36 months after discharge. The effect size (Cohen's d) was calculated for the sensitivity to change during the inpatient course. The interrater reliability and agreement with the HEMB‑L were determined taking the evaluation of the audio files by blinded examiners into account.
Between 29 April 2019 and 25 June 2021 a total of 124 patients were included in the study. The Barthel Index scores obtained using the Bplus and HEMB‑L did not show a significant difference. The interrater reliability, internal consistency and change sensitivity of the Bplus were high, each at > 0.9. For activities performed independently but with impairment, there was an increased risk of care dependency occurring over the course of the study.
While maintaining the same sum score as the HEMB‑L, the Bplus can highlight abilities prone to a high risk for loss of independence and thus facilitate the prevention of progressive care dependency.
巴氏指数是评估基本自我护理能力最常用的工具；然而，它仅在需要个人支持的阶段首次记录损伤情况。
基于《汉堡分类手册》（HEMB-L）的长版本，在与专业护理人员协商后开发了Barthel plus（Bplus），作为一种操作化方法，它还通过中立评分来描述代偿性损伤。本文介绍了该工具及其质量特征。
对于急性老年护理患者，Bplus在间隔超过1周的时间内使用两次，并进行录音。在出院后1、12、24和36个月通过电话对Bplus进行评估。计算住院期间变化敏感性的效应量（科恩d值）。考虑到由不知情的检查人员对音频文件进行评估，确定了评分者间信度以及与HEMB-L的一致性。
在2019年4月29日至2021年6月25日期间，共有124名患者纳入研究。使用Bplus和HEMB-L获得的巴氏指数评分没有显著差异。Bplus的评分者间信度、内部一致性和变化敏感性都很高，均>0.9。对于独立进行但有损伤的活动，在研究过程中出现护理依赖的风险增加。
在保持与HEMB-L相同总分的同时，Bplus可以突出显示易出现独立能力丧失高风险的能力，从而有助于预防渐进性护理依赖。
