Early discharge after stroke

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1168b (Published 11 April 1998) Cite this as: BMJ 1998;316:1168

Use of Barthel index was not appropriate

  1. Torgeir Bruun Wyller, Research fellow
  1. Department of Geriatric Medicine, Ullevaal Hospital, N-0407 Oslo
  2. Elderly Care Unit, Guy's and St Thomas's NHS Trust, London SE1 7EH
  3. Department of Public Health, UMDS, St Thomas's Hospital, London SE1 7EH
  4. Centre for Health Planning and Management, Keele University, Keele, Staffordshire ST5 5BG

    EDITOR—There are three reasons why Rudd et al may be at fault when they conclude that early discharge of patients with stroke has no clinical importance.1

    Firstly, the authors used the Barthel index as the main outcome measure. This scale is insensitive to change at higher scores.2 More than 1 in 10 of the patients had a maximum Barthel score at randomisation, and improvement therefore cannot be shown in these patients with this index. The study was powered to detect a 3.5 point difference in the Barthel index. To be able to detect such a difference, the Barthel score should have been ⩽16.5 at the start of the …

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