The Spanish versions of the Barthel index (BI) and the Katz index (KI) of activities of daily living (ADL): A structured review

https://doi.org/10.1016/j.archger.2008.09.006Get rights and content

Abstract

In this article, the evidence relating to the appropriateness to the target population, practicality and psychometric properties of the BI and the KI of ADL on samples of Spanish old people has been evaluated. To obtain the original documents electronic searches were carried out in Spanish databases and in international databases, MEDLINE, PsycInfo, CINAHL and EMBASE, as well as manual searches and references searches. Twenty articles met the inclusion criteria. The results show a large number of versions, for the two instruments, with weak processes of transcultural adaptation, without standards for its administration, nor for its interpretability. The most evaluated point of reliability was the interrater reproducibility. The evidence about predictive validity is extensive, but the evidence about concurrent validity and responsiveness is very scarce.

Introduction

The activities of daily living (ADL) are the main focus of the measures of health and quality of life of the elderly (Spector and Fleishman, 1998). In the Gerontological research, the inclusion of the ADL measures as indicators of functional disability is almost as common as age, gender and marital status (Rodgers and Miller, 1997). Functional disability is the main predictor, after age, of important results: mortality, the use of health services and institutionalization, the incidence of acute diseases, falls and injuries, and the deterioration of the functional capacity (Guralnik et al., 1996).

The measures of ADL include the subdomains of self-care and mobility (Wiener et al., 1990, Avlund, 1997). Among the instruments of ADL, from their development to present time, the BI and the KI ADL have turned into standards of measures in the research into old people (Ciesla et al., 1993, Sainsbury et al., 2005). The first one was developed initially by Mahoney and Barthel (1965) for the assessment and monitoring of the functional capacity of patients with neuromuscular or musculoskeletal disorders at the chronic disease hospitals in Maryland. The second one was elaborated by the staff at Benjamin Rose Hospital from observations of a large number of activities performed by a group of patients with fracture of the hip and later on old people and chronic patients (Katz et al., 1963).

The BI is an instrument of clinical application, which can be administered by a member of the medical staff, in 2–5 min or self-administered in about 10 min and it has been used in many studies. Whereas the evidence of its reliability is excellent, the evidence of its validity is only satisfactory (McDowell, 2006). The KI is also a clinical measure, administered by a member of the staff and widely used. However, the information about its reliability is very basic and weak, whereas its validity is considered adequate, even though only a few types of validity have been examined or just a few studies report about it (McDowell, 2006).

Haywood et al. (2004) revised the measures of the status of health in the elderly, but the measures of specific domain were not included, like for example those of ADL/IADL (instrumental ADL). The most recent revision of any of these scales is the one by Sainsbury et al. (2005) about the reliability of the BI.

In Spanish literature, a review of health measures concluded that the KI (the Spanish version) had a low level of development, solely reporting findings about its reliability, in just one study. The BI was not included in that review (Badía et al., 2002).

The aim of this article was evaluating the evidence related to the appropriateness to the target population, practicality and psychometric properties of the BI and the KI of ADL in Spanish elderly people.

Section snippets

Search strategy

The search strategy was designed to obtain original studies on the development, the use and the validation of the instruments of functional assessment of old people, but in this study only the information about the BI and the KI of ADL has been presented.

To obtain original documents, electronic searches were carried out in the Spanish database IME (Spanish Medical Index), which gather the production of Spanish medical journals and ISOC (Social Science and Humanities Index), which collect the

Search strategy

Seventy-four articles complied with the criteria of inclusion. The electronic searches gave 33 documents and the manual ones 33, with an overlap between them of 10 articles. The searches by instruments and authors gave 8 additional papers and from references 10 more were obtained. Out of all those 45 articles, were excluded which did not show bibliographical information of the version used, or where an English original was used as reference. Therefore, 29 articles were included, of which 20

Discussion

In this study the gathered evidence has been examined, in our country, on the two most used ADL scales in the international literature, the BI and the KI, with old people, both in the clinical practice and in research. The extracted information has been analyzed in accordance with three main axes: appropriateness to the target population, practicality and psychometric properties. The data show that, there is no standardized version for neither scale, but many translations of the original

Conflict of interest

None.

References (65)

  • B. Artaso et al.

    Valoración funcional directa e indirecta del paciente con demencia

    Geriátrika

    (2002)
  • K. Avlund

    Methodological challenges in measurements of functional ability in gerontological research. A review

    Aging (Milano)

    (1997)
  • K. Avlund et al.

    Construct validity and the Rasch model: functional ability of health elderly people

    Scand. J. Soc. Med. Suppl.

    (1993)
  • X. Badía et al.

    La medida de la salud. Guía de escalas de medición en español

    (2002)
  • J.J. Baztán et al.

    Índice de Barthel: instrumento valido para la valoración funcional de pacientes con enfermedad cerebrovascular

    Rev. Esp. Geriatr. Gerontol.

    (1993)
  • J.J. Baztán et al.

    Ganancia funcional y estancia hospitalaria en la unidad de geriatría de media estancia del Hospital Central de la Cruz Roja de Madrid

    Rev. Esp. Salud Publica

    (2004)
  • J.J. Baztán et al.

    Resultados al año de la rehabilitación tras fractura de fémur proximal en mayores de 84 años

    An. Med. Interna

    (2004)
  • A. Bowlling

    La medida de la salud. Revisión de las escalas de medida de la calidad de vida

    (1994)
  • M.J. Cabañero-Martínez et al.

    Revisión estructurada de las medidas de actividades de la vida diaria en personas mayores

    Resv. Esp. Geriatr. Gerontol

    (2008)
  • E. Casiano et al.

    Assessing functional status measures in older adults: a guide for healthcare professionals

    Phys. Ther. Rev.

    (2002)
  • J. Cid et al.

    Valoración de la discapacidad física: El Índice de Barthel

    Rev. Esp. Salud Publica

    (1997)
  • J.R. Ciesla et al.

    Reliability of Katz's activities of daily living scale when used in telephone interviews

    Eval. Health Prof.

    (1993)
  • J. Cohen

    Statistical Power Analysis for the Behavioral Sciences

    (1977)
  • M.E. Cohen et al.

    The tools of disability outcomes research functional status measures

    Arch. Phys. Rehabil.

    (2000)
  • C. Collin et al.

    The Barthel ADL Index: a reliability study

    Int. Disabil. Stud.

    (1988)
  • W.J. Coster et al.

    Refining the conceptual basis for rehabilitation outcome measurement

    Med. Care

    (2004)
  • A.J. Cruz

    El Índice de Katz

    Rev. Esp. Geriatr. Gerontol.

    (1991)
  • A.F. Cruz

    Evaluación de la función física en el anciano

    Medicine

    (1991)
  • G. Diestre et al.

    Evaluación de la capacidad funcional y características de los pacientes ingresados en la Unidad de Convalecencia y Rehabilitación (UCR)

    Rev. Mult. Gerontol.

    (2000)
  • C. Fontana et al.

    Concordancia entre índices de dependencia en las actividades de la vida diaria. Experiencia de aplicación en la población geriátrica de ámbito rural

    Enferm. Clín.

    (2002)
  • J.I. González et al.

    Valoración funcional: comparación de la Escala de Cruz Roja con el Índice de Katz

    Rev. Esp. Geriatr. Gerontol.

    (1991)
  • J.I. González et al.

    La intervención geriátrica puede mejorar el curso clínico de los ancianos frágiles con fractura de cadera

    Med. Clin. (Barc.)

    (2001)
  • Cited by (70)

    • Prevalence of transthyretin cardiac amyloidosis in elderly patients diagnosed with heart failure

      2023, Revista Espanola de Geriatria y Gerontologia
      Citation Excerpt :

      All patients with a previous diagnosis that could indicate moderate or severe ventricular hypertrophy were excluded; such conditions included poorly controlled high blood pressure (HBP) (mean values in daytime ambulatory blood pressure monitoring (ABPM) above 139/89 mmHg), moderate or severe aortic valve disease, a mechanical or biological valve prostheses, history of hypertrophic or restrictive cardiomyopathy, and history of significant coronary artery disease, defined as prior myocardial infarction, stenosis of a left main vessel or of the proximal anterior descending artery, or significant stenosis in two coronary arteries. Demographic and analytical parameters were collected, and a geriatric specialist doctor carried out a comprehensive geriatric assessment, which included the determination of different variables, namely, basic activities of daily living (BADL) using the Barthel Index8; instrumental activities of daily living (IADL) using the Lawton IADL Scale9–11; frailty measurement using the short physical performance battery (SPPB)12 and Fried phenotype,13 classifying patients as fragile/prefrail or robust; a history of dementia and/or cognitive impairment; a history of repeated falls (defined as 2 or more falls in the previous six months); a history of depression according to DSM-V criteria14; and comorbidity measured by the Charlson index.15 The ultrasound study was performed using a Philips Affiniti 70 ultrasound machine.

    • Relationship between negative stereotypes toward aging and multidimensional variables in older people living in two different social environments

      2022, Archives of Gerontology and Geriatrics
      Citation Excerpt :

      For community-dwelling older adults, all sociodemographic variables were collected during an interview. To determine eligibility for the study, NH resident autonomy was evaluated using a modified Barthel index (Cabañero-Martínez, Cabrero-García, Richart-Martínez & Muñoz-Mendoza, 2009; Shah, Vanclay & Cooper, 1989) and the community-dwelling group was evaluated using the original Barthel index (González et al., 2018; Mahoney & Barthel, 1965). The Barthel index scores independence in personal care and mobility out of a maximum 100 points.

    • Handgrip strength predicts 1-year functional recovery and mortality in hip fracture patients

      2020, Maturitas
      Citation Excerpt :

      Demographic data such as age, sex and institutionalization were collected, as well as clinical data such as the type of HF and surgery and the surgical risk according to the American Society of Anesthesiologists (ASA) scale. A clinical history was performed which included baseline clinical variables such as previous diseases, anticoagulation, Charlson comorbidity index, and functional variables such as the baseline Functional Ambulation Categories (FAC) (Holden et al., 1984) [16], baseline and admission Barthel Index [17]. The FAC scale assesses walking ability at levels ranging from 0 (disability) to 5 (independence to walk on all types of surfaces).

    View all citing articles on Scopus
    View full text