Wellwood I, Dennis M S, Warlow C P
Department of Clinical Neurosciences, Western General Hospital, Edinburgh.
Age Ageing. 1995 Jan;24(1):54-7. doi: 10.1093/ageing/24.1.54.
The Barthel Index has been widely adopted as a measure of disability. The Office of Population Censuses and Surveys (OPCS) disability instrument was developed to provide a comprehensive measure of disability for use in the 1985 survey of disability among adults. Both measures were used on 150 patients surviving 1 year from a consecutive cohort of 246 admissions to hospital with acute stroke. The Barthel Index when summed across categories (as is commonly done), correlated reasonably well with the OPCS disability instrument [-0.73 (p < 0.001) 95% CI 0.64 to 0.80] despite its reliance on arbitrary weights and the omission of categories for communication, vision, hearing and intellectual disability. The broader scope of the OPCS instrument explained most of the floor and ceiling effects seen with the Barthel Index. The Barthel Index continues to have a useful role in stroke rehabilitation when used as a checklist for rehabilitation goals set by clinicians, as a predictor of long-term outcome and as an overall measure of disability or activities of daily living in descriptive studies, randomized controlled trials and audit. However, its floor and ceiling effects may lead to an underestimation of patients' and carers' problems in up to a third of patients. The OPCS instrument may prove to be a more useful outcome measure in randomized controlled trials and audits by virtue of its comprehensive nature.
巴氏指数已被广泛用作残疾程度的衡量指标。人口普查与调查办公室（OPCS）的残疾评定工具旨在为1985年的成人残疾调查提供一种全面的残疾衡量方法。在246例因急性中风入院的连续队列中，对150例存活1年的患者同时使用了这两种测量方法。巴氏指数按类别相加（通常做法）时，尽管其依赖任意权重且遗漏了沟通、视力、听力和智力残疾类别，但与OPCS残疾评定工具的相关性相当好[-0.73（p<0.001），95%置信区间为0.64至0.80]。OPCS评定工具更广泛的范围解释了巴氏指数出现的大部分地板效应和天花板效应。当巴氏指数用作临床医生设定康复目标的检查表、长期预后的预测指标以及描述性研究、随机对照试验和审计中残疾或日常生活活动的总体衡量指标时，它在中风康复中仍发挥着有用的作用。然而，其地板效应和天花板效应可能导致高达三分之一的患者的问题被低估。由于OPCS评定工具的全面性，它可能在随机对照试验和审计中被证明是一种更有用的结果测量指标。
