Comparing the Responsiveness of Barthel Index and Longshi Scale in Assessing the ADL of Stroke Survivors
Condition: Disability Physical; Stroke
MeSH terms: Stroke
Study type: Observational

Summary: 
      The aim of this research was to compare the responsiveness of Barthel Index (BI) and Longshi
      Scale (LS) for assessing activities of daily living (ADL) in stroke survivors at different
      stage and we also aimed to observe changes of ADL score in stroke survivors over time.
    

Detailed description: 
      The whole experiment process has been supervised by a research assistant, and all the data
      collected are recorded on paper case report forms. The research assistant also takes charge
      of checking the consistency of data enter into the registry against predefined rules. Stroke
      survivors in Shenzhen Second People's Hospital have been invited to participate in this study
      and divide into three groups according to their duration of stroke (acute stroke, subacute
      stroke and chronic strike).

      Data collection:

      Baseline information was collected within 24 hours of admission. ADL of stroke survivors was
      assessed on admission, at discharge and 3 months after discharge.

      Sample size calculation:

      The sample size in this study was calculated according to the sample size calculation
      formula: n=[(µα+µβ)(µα+µβ)(1+1/k)p(1-p)]/(pe-pc)(pe-pc). Investigations in many places in
      China showed that varying degrees of dysfunction remain in 70%-80% of stroke survivors, and
      the disability rate is 30.2%-62.8%. In this reserach，p=(pe+kpc)/(1+k)，pe=0.3，pc =0.6,
      α=0.05，β=0.1, so µ0.05=1.6449，µ0.10=1.2816，thus the sample size in our study was n=47. We
      assume that 10% of them loss to follow-up, thus the sample size in our study was 52 in each
      group.

      Statistical analysis:

        1. Internal responsiveness First, standardized effect size (SES) was calculated by dividing
           the mean change in score between admission and discharge assessments by the standard
           deviation (SD) of the admission score. second, the standardized response mean (SRM) was
           obtained by dividing the mean change scores by the SD of the change score between
           admission and discharge scores. A value of SES or SRM>0.8 was large, 0.5 to 0.8
           moderate, and 0.2 to 0.5 small.

        2. External responsiveness The pearson correlation coefficient (r) was used to investigate
           the external responsiveness. An r value >0.75 represented good to excellent association;
           values of 0.50 to 0.75, moderate to good association; values of 0.25 to 0.50, fair
           association; and values ≤0.25, little association between the changes in scores on these
           measures. And the significance threshold was set at 0.05.

        3. Receiver operating characteristic (ROC) curve For this study, the area under ROC curve
           (AUC) obtained by comparing subjects who improved by one or more levels on the modified
           Rankin scale vs. those who exhibit no change on the modified Rankin scale. Larger AUC
           means higher screening accuracy. In general, an AUC of 0.5 suggests no discrimination,
           0.7 to 0.8 is considered acceptable, 0.8 to 0.9 is considered excellent, and more than
           0.9 is considered outstanding.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Stroke survivors from the Department of Rehabilitation Medicine at Shenzhen Second People's
        Hospital are invited to participate in this study according to the inclusion and exclusion
        criteria.