A comparison of the Barthel Index and the Functional Independence Measure as outcome measures in stroke rehabilitation: patterns of disability scale usage in clinical trials

In order to compare the frequency and patterns of use of the Barthel Index (BI) and Functional Independence Measure (FIM) in stroke rehabilitation trials, all randomized controlled trials (RCTs) of stroke rehabilitation published between 1968 and 2002 were identified and reviewed to determine the frequency with which the BI and FIM measures were used relative to other measures of disability. The date and location of each study citing either the FIM or the BI were also recorded. Studies were assigned ratings of methodological quality based on the physiotherapy evidence database (PEDro) scoring system. Comparisons of the age, frequency and continents of origin and methodological quality of the studies were explored. Results indicate that the BI and FIM were the most common measures of disability used in RCTs examining stroke rehabilitation. However, the BI was used more often than the FIM (n=86, P < 0.001) and was cited in trials of superior quality (P=0.005). Studies from North America were more likely to use the FIM compared with European studies (n=24, P < 0.001). Publications citing the BI were significantly more recent when originating in Europe as opposed to North America (P=0.023). These results provide insight into current patterns of scale use in stroke rehabilitation research.