Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living
IntroductionFunctional dependence on the performance of basic activities of daily living (ADLs) is associated with increased mortality. In this study, the Barthel index and its activities discriminate long-term mortality risk, and whether changes in this index are necessary to adapt it to detect mor...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1478897/full |
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| author | Vicente Martín Moreno Vicente Martín Moreno María Inmaculada Martínez Sanz Amanda Martín Fernández Sara Guerra Maroto Eva Sevillano Fuentes Elena Pérez Rico Irene Sánchez González Miriam Fernández Gallardo Julia Herranz Hernando María Palma Benítez Calderón Laura Calderón Jiménez Elena Sánchez Rodríguez Miguel Recuero Vázquez Helena Alonso Samperiz Irene León Saiz Juana Marcos Guerra |
| author_facet | Vicente Martín Moreno Vicente Martín Moreno María Inmaculada Martínez Sanz Amanda Martín Fernández Sara Guerra Maroto Eva Sevillano Fuentes Elena Pérez Rico Irene Sánchez González Miriam Fernández Gallardo Julia Herranz Hernando María Palma Benítez Calderón Laura Calderón Jiménez Elena Sánchez Rodríguez Miguel Recuero Vázquez Helena Alonso Samperiz Irene León Saiz Juana Marcos Guerra |
| author_sort | Vicente Martín Moreno |
| collection | DOAJ |
| description | IntroductionFunctional dependence on the performance of basic activities of daily living (ADLs) is associated with increased mortality. In this study, the Barthel index and its activities discriminate long-term mortality risk, and whether changes in this index are necessary to adapt it to detect mortality risk is examined.MethodsLongitudinal study, carried out at the Orcasitas Health Center, Madrid (Spain), on the functional dependent population (Barthel ≤ 60). It included 127 people, with a mean age of 86 years (78.7% women and 21.3% men). Functional capacity was assessed using the Barthel index, and this index and each item it contains were analyzed as a test in relation to survival at three years, using tools that evaluate precision, discrimination, and calibration. The date of death was obtained from the health system.ResultsGreater dependency to perform chair-to-bed transfers was associated with an increased mortality risk (HR 2.957; CI 1.678–5.211). Also, individuals with severe (HR 0.492; CI 0.290–0.865) and moderate (HR 0.574; CI 0.355–0.927) ADL dependence had a reduced mortality risk when more independent in chair-to-bed transfers. Among people with moderate ADL dependence, this percentage was 48%. Using dependence-independence for chair-to-bed transfer as a screening test for mortality, the test showed high sensitivity (0.91) and specificity (0.83), a positive likelihood ratio of 5.45, and a negative likelihood ratio of 0.11. The area under the ROC curve was 0.814 (CI 0.658–0.970; p = 0.001), with a χ2 = 0.235; p = 0.889, according to the Hosmer–Lemeshow test. The concordance C index was 0.814. According to Nagelkerke’s R2, the model explained 53.1% of the variance in survival. As a screening test, “chair-to-bed transfer” was superior to the Barthel index.ConclusionADL dependence for chair-to-bed transfers is an independent risk factor for mortality for any level of dependency. Therefore, a new classification of the Barthel index is proposed, in which “being dependent or requiring great assistance to perform chair-to-bed transfers” is considered severe dependence, even when the total score obtained via the Barthel Index is ≥40. We propose its use as a screening test in parallel to the Barthel index. The study suggests that the Barthel Index may have limitations in adequately discriminating mortality risk. |
| format | Article |
| id | doaj-art-bd172c90092b47f090649f077a90fbff |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-bd172c90092b47f090649f077a90fbff2025-01-14T05:10:33ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-01-011210.3389/fpubh.2024.14788971478897Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily livingVicente Martín Moreno0Vicente Martín Moreno1María Inmaculada Martínez Sanz2Amanda Martín Fernández3Sara Guerra Maroto4Eva Sevillano Fuentes5Elena Pérez Rico6Irene Sánchez González7Miriam Fernández Gallardo8Julia Herranz Hernando9María Palma Benítez Calderón10Laura Calderón Jiménez11Elena Sánchez Rodríguez12Miguel Recuero Vázquez13Helena Alonso Samperiz14Irene León Saiz15Juana Marcos Guerra16Orcasitas Health Care Center, Madrid, Spaini+12 Research Institute, Doce de Octubre Hospital, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainGrupo Polibea Concierto, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainOrcasitas Health Care Center, Madrid, Spaini+12 Research Institute, Doce de Octubre Hospital, Madrid, Spaini+12 Research Institute, Doce de Octubre Hospital, Madrid, SpainOrcasitas Health Care Center, Madrid, SpainIntroductionFunctional dependence on the performance of basic activities of daily living (ADLs) is associated with increased mortality. In this study, the Barthel index and its activities discriminate long-term mortality risk, and whether changes in this index are necessary to adapt it to detect mortality risk is examined.MethodsLongitudinal study, carried out at the Orcasitas Health Center, Madrid (Spain), on the functional dependent population (Barthel ≤ 60). It included 127 people, with a mean age of 86 years (78.7% women and 21.3% men). Functional capacity was assessed using the Barthel index, and this index and each item it contains were analyzed as a test in relation to survival at three years, using tools that evaluate precision, discrimination, and calibration. The date of death was obtained from the health system.ResultsGreater dependency to perform chair-to-bed transfers was associated with an increased mortality risk (HR 2.957; CI 1.678–5.211). Also, individuals with severe (HR 0.492; CI 0.290–0.865) and moderate (HR 0.574; CI 0.355–0.927) ADL dependence had a reduced mortality risk when more independent in chair-to-bed transfers. Among people with moderate ADL dependence, this percentage was 48%. Using dependence-independence for chair-to-bed transfer as a screening test for mortality, the test showed high sensitivity (0.91) and specificity (0.83), a positive likelihood ratio of 5.45, and a negative likelihood ratio of 0.11. The area under the ROC curve was 0.814 (CI 0.658–0.970; p = 0.001), with a χ2 = 0.235; p = 0.889, according to the Hosmer–Lemeshow test. The concordance C index was 0.814. According to Nagelkerke’s R2, the model explained 53.1% of the variance in survival. As a screening test, “chair-to-bed transfer” was superior to the Barthel index.ConclusionADL dependence for chair-to-bed transfers is an independent risk factor for mortality for any level of dependency. Therefore, a new classification of the Barthel index is proposed, in which “being dependent or requiring great assistance to perform chair-to-bed transfers” is considered severe dependence, even when the total score obtained via the Barthel Index is ≥40. We propose its use as a screening test in parallel to the Barthel index. The study suggests that the Barthel Index may have limitations in adequately discriminating mortality risk.https://www.frontiersin.org/articles/10.3389/fpubh.2024.1478897/fullbasic activities of daily livinginstrumental activities of daily livingBarthel indexfunctional impairmentmobilitydependence |
| spellingShingle | Vicente Martín Moreno Vicente Martín Moreno María Inmaculada Martínez Sanz Amanda Martín Fernández Sara Guerra Maroto Eva Sevillano Fuentes Elena Pérez Rico Irene Sánchez González Miriam Fernández Gallardo Julia Herranz Hernando María Palma Benítez Calderón Laura Calderón Jiménez Elena Sánchez Rodríguez Miguel Recuero Vázquez Helena Alonso Samperiz Irene León Saiz Juana Marcos Guerra Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living Frontiers in Public Health basic activities of daily living instrumental activities of daily living Barthel index functional impairment mobility dependence |
| title | Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living |
| title_full | Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living |
| title_fullStr | Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living |
| title_full_unstemmed | Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living |
| title_short | Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living |
| title_sort | proposal for a revised barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living |
| topic | basic activities of daily living instrumental activities of daily living Barthel index functional impairment mobility dependence |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1478897/full |
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