A Comparative Study Of The Responsiveness Of Longshi Scale And Barthel Index In Evaluating The Ability To Perform Activities Of Daily Living In Stroke Survivors

Objective:To compare the responsiveness of Longshi Scale（LS）with that of Barthel Index（BI）by evaluating activities of daily living of stroke survivors at different recovery stages,and to observe the how stroke survivors’functional ability changes over time to provide basis and reference for the selection of evaluation tools in clinical setting.Methods:A total of 180 patients who met the inclusion and exclusion criteria were selected from Department of Rehabilitation Medicine of The Second People’s Hospital of Shenzhen from July 2020 to August 2021.Demographic information,disease characteristics and the modified Rankin scale（m RS）scores were collected at admission to the department.According to the course of disease,patients were divided in three groups:acute phase,subacute phase and chronic phase.Patients in each group were assessed using the LS and BI at admission,discharge,and 3 months after discharge to detect their functional change.The responsiveness of the scale was measured from two aspects:internal responsiveness and external responsiveness.The Mc Nemar’s test was used to explore the internal responsiveness of the two scales by testing whether there was a statistic difference in the number of people who had a functional change in two assessment tools.Spearman’s rank correlation coefficient and receiver operating characteristic（ROC）curve analysis were used to determine the scales’external responsiveness.Finally,a line graph was drawn to observe the trend of patients’ability to perform activities of daily living over time.Results:In our study,29 subjects dropped out due to poor compliance or refusal to follow up,9 patients were excluded due to declined m RS grade,while 142 subjects（98 were male and 44 were female）were included in the statistical analysis.There were 65 patients with cerebral hemorrhage and77 patients with ischemic stroke.The results showed that LS could detect more changes in functional status than Barthel index among patients in acute phase（P=0.013）and the chronic phase（P=0.021）at discharge,but there was no statistical difference in the number of patients who had changes in functional status detected by the two scales three months after discharge.There was no difference in the number of patients in the subacute phase who changed in functional status on either the discharge assessment or the 3-month follow-up after discharge.In the discharge assessment,the areas under the curves of the receiver operating characteristic curve were0.675（95%CI:0.591～0.751）and 0.784（95%CI:0.709～0.849）for the LS and BL respectively.The areas under ROC curve at three months after discharge were 0.781（95%CI:0.703～0.846）and 0.820（95%CI:0.747～0.880）respectively.Spearman’s rank correlation coefficient analysis showed that the correlation between the scores detected by LS and BI at discharge and three months after discharge was r₁=0.535 and r₂=0.662.Finally,it was observed by drawing a line chart that patients in acute phase had the most significant change in ADL,followed by patients in subacute phase,and patients in chronic phase had the least change in ADL,regardless of whether patients were assessed by LS or BI.That is to say,the improvement of the patients’ability of daily living decreased gradually over time.Conclusions:The novel pictorial LS showed similar internal and external responsiveness with BI,and even superior to BI when evaluating stroke survivors in acute and chronic phase at discharge.Our previous study showed that compared with BI,LS is more convenient in evaluating ADL and the evaluation results are easier to understand,which can be better understood and accepted by the disabled and their families.Therefore,in the future clinical and scientific research work,LSmay be a better choice than BI for evaluating the changes of ADL of stroke patients,especially for survivors in acute and chronic phase.