Barthel index

The primary outcome of NINDS part II was a favorable outcome at 3 months, as assessed by four commonly used assessment scales the Barthel Index (BI), modihed Rankin Scale (mRS), Glasgow Outcome Scale (GOS), and NIHSS. A... 

FIGURE 3.2 Differences between IV rt-PA and placebo-treated patients on four assessment scales using data taken from part II of the 1995 NINDS trial. Values do not total 100% because of rounding. The odds ratio for a global favorable outcome with intravenous rt-PA was 1.7 (95% Cl 1.2-2.6, p = 0.008). The global favorable outcome was defined as NIHSS, 0-1 Barthel Index, 95-100 modified Rankin Scale, 0-1 and Glasgow Outcome Scale, 5. 

FIGURE 5.2 Clinical outcome of patients in the double-blind, proof-of-concept trial evaluating EPO in acute stroke, (a) Barthel Index (rhEPO vs. placebo, p < 0.05). (b) Modified Rankin Scale (rhEPO vs. placebo, p < 0.07) on day 30. Dead patients received the worst possible score. Evolution of lesion size of patients in the efficacy trial of Albumin in acute stroke, ((a-1) and DWI and (a-2) FLAIR.) (Reprinted with permission from reference 50.)... 

The Trial of Org 10172 in Acute Stroke Treatment (TOAST) was a randomized, double-blind, placebo-controlled trial of danaparoid in 1281 patients within 24 hours of onset of acute ischemic stroke. A three-stage dosage regime was used to achieve plasma anti-factor Xa activity of 0.8 unit/mL. Favorable outcome was defined as the combination of a Glasgow Outcome Scale (GOS) score of 1 or 2 and a modified Barthel Index (BI) score of 12 or greater (on a scale of 0-20) at 3 months or 7 days. Very favorable outcome required the combination of a GOS score of 1 and a Barthel Index (BI) score of 19 or 20 at 3 months or 7 days. 

Stroke patients who require mechanical ventilation are not necessarily destined for a poor outcome. In a study by Santoli et al., 58 patients underwent mechanical ventilation and 16 survived. Eleven achieved a Barthel Index (BI) score of 60, indicating a good outcome. Within this study population, those patients with bilaterally absent comeal and pupillary reflexes had uniformly poor outcomes, underscoring the need for careful assessment of brainstem reflexes in intubated stroke patients. Other factors that have been associated with poor outcome in intubated stroke patients are advanced age and lower Glasgow Coma Score (GCS) at the time of intubation, as well as seizures and pulmonary edema. ... 

Pillai et al. J Neurosurg 2007 106(1) 59-65 Prospective study decompression with durplasty various stages of mass occupying MCA infarct 26 patients with mean age of 48 and mean preop GCS of 9.9 Immediate and long-term intervention by survival and functional outcome 73% survival at 1 year 33% independent, and 55% partially independent by Barthel Index. No patients in PVS... 

In a parallel group, placebo-controlled trial in acute stroke the primary endpoint is success on the Barthel index at month 3. Previous data suggests that the success rate on placebo will be 35 per cent and it is required to detect an improvement in the active treatment group to 50 per cent. How many patients are needed for 90 per cent power ... 

This was a multi-centre, pan-European, randomised double-blind placebo-controlled clinical trial in acute stroke to evaluate the effect of ancrod, a natural defribrinogenating agent (Hennerici et al. (2006)). The primary endpoint was based on the Barthel Index a favourable score of 95 or 100 or a return to the pre-stroke level at three months was viewed as a success. The primary method of statistical analysis was based on a logistic model including terms for treatment, age category, baseline Scandinavian Stroke Scale and centre. 

Rohl, L., et al., Correlation between diffusion- andperfusion-weighted MRI and neurological deficit measured by the Scandinavian Stroke Scale and Barthel Index in hyperacute subcortical stroke (< or = 6 hours). Cerebrovasc Dis, 2001. 12(3) p. 203-13. 

The objective, clinical assessment of the stroke patient is important for therapeutic decisions and prognosis. The most valuable instrument during the acute stroke period is the NIH stroke scale, which is listed in Table 11.7. Two other commonly used clinical stroke scales to assess premorbid functioning or long-term functional recovery are the Modified Rankin Scale (Table 11.8) and the Barthel Index (Table 11.9). 

Table 11.9 Barthel Index [89] http //www.neuro.mcg.edu/mcgstrok/lndices/Barthel lnd.htm ...

Mahoney, F.I., Barthel, D.W. Functional evaluation the Barthel Index. Maryland State Medical Journal 14, 61-66 (1965)... 

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