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