Assessment of interobserver variability in a Dutch multicenter study on acute ischemic stroke
- HJ Gelmers, K Gorter, CJ de Weerdt, HJA Wiezer
To the Editor: Descriptions of the natural history of brain infarction and evaluation of therapeutic interventions rely on definitions of the degree of handicap and neurologic deficit of the patients. The Barthel index is the best known of the functional evaluation systems since it is the easiest to perform. The index describes basically the degree of independence from nursing care or other medical help. The maximum score of 100 reflects a high degree of independence, but not freedom from symptoms, since handicaps related to speech impediments are not included in the evaluation. At the lower end of the scale, improvement in the patient's condition is not reflected in a higher score. Therefore, the Barthel index is not suitable for an evaluation of subtle therapeutic effects despite a close correlation with the neurologic score up to the level of relative autonomy at a score of approximately 60 points.