The Barthel Index in assessing the response to palliative radiotherapy in malignant spinal cord compression: a prospective audit.

A prospective study of functional assessment of response to palliative radiotherapy (RT) in malignant spinal cord compression (SCC) is reported. The relevant components of the Barthel Activities of Daily Living Index (ADLI: walking, transfer, and bladder and bowel control) were used to assess functional capacity, and compared with a standard neurological assessment. Fifty-one consecutive patients (38 men, 13 women; mean age 63.9 years) were assessed, all of whom were treated by primary or postoperative radiotherapy. Five of the 51 patients had had decompressive laminectomy prior to RT. Median survival was 34 days (range 2-570). Walking improved in only five of 12 patients who had an improvement in motor power. The ability to transfer from bed to chair improved in 11 patients. Ambulation at presentation was the single most important determinant of outcome. Of the eight patients ambulatory at presentation, all were alive at 1 month and seven remained ambulatory. Of the 43 non-ambulatory patients, only four were able to walk following treatment (all prostatic carcinomas). Only four patients regained urinary continence, and none regained bowel control after this was lost. Functional assessment using ADLI and standard neurological examination provide a more useful guide to outcome in malignant SCC than neurological examination alone.