Relationship between the modified Rankin Scale and the Barthel Index in the process of functional recovery after stroke

The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most  
common clinimetrical instruments for measuring disability after stroke. 

This study [here] 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. 


Methods: 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. 


Results: 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.


Conclusion: Maximum sensitivity of mRS in differentiating functional 

recovery is reached at six months post-stroke.