Reliability of the Barthel Index Outcome Measure Selected for the NINDS t-PA Stroke Trial

  • P. D. Lyden
  • J. Broderick
  • E. Mascha
  • The NINDS t-PA Stroke Trial Investigators
Conference paper


In October of 1990, the National Institute for Neurologic Disorders and Stroke (NINDS) launched a randomized, placebo-controlled, blinded, multicenter trial of tissue recombinant plasminogen activator (rt-PA) for acute stroke. Patients must present to a participating hospital quickly enough to receive intravenous rt-PA within 90 or 180 min after stroke onset. The two treatment tiers are balanced through randomization procedures so that equal numbers of patients are treated before 90 min and before 180 min after onset. The two time limits are necessary to extend the promising results of pilot rt-PA stroke studies, which used a 90 min time limit, to a longer enrollment window [1,2]. Patients with ischemic stroke in the carotid or vertebrobasilar territories are eligible, and the study is active in seven cities in the United States (see Appendix for list of investigators and sites).


Interrater Reliability Barthel Index Glasgow Outcome Scale Stroke Trial Barthel Index Score 
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  1. 1.
    Brott TG, Haley EC Jr, Levy DE, et al (1992) Urgent therapy for stroke: Part 1. Pilot study of tissue plasminogen activator administered within 90 minutes. Stroke 23: 632–640PubMedCrossRefGoogle Scholar
  2. 2.
    Haley EC Jr, Levy DE, Brott TG, et al (1992) Urgent therapy for stroke: Part II. Pilot study of tissue plasminogen activator administered 91–180 minutes from onset. Stroke 23: 641–645PubMedCrossRefGoogle Scholar
  3. Brott T, Adams HP. Olinger CP, et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870PubMedCrossRefGoogle Scholar
  4. 4.
    Goldstein LB, Bartels C, Davis JN (1989) Interrater reliability of the NIH stroke scale. Arch Neurol 46: 660–662PubMedCrossRefGoogle Scholar
  5. 5.
    Lyden PD, Brott T, Tilley B, et al (1994) Improved reliability of the NIH stroke scale using video training. Stroke 25: 2220–2226PubMedCrossRefGoogle Scholar
  6. 6.
    Lyden PD, Lau GT (1991) A critical appraisal of stroke evaluation and rating scales. Stroke 22: 1345–1352PubMedCrossRefGoogle Scholar
  7. 7.
    Rankin J (1957) Cerebral vascular accidents in patients over the age of 60: prognosis. Scott Med J 2: 200–215PubMedGoogle Scholar
  8. 8.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 2: 480–484CrossRefGoogle Scholar
  9. 9.
    Mahoney FT, Barthel DW (1965) Functional evaluation: Barthel Index. Md State Med J 14: 61–65Google Scholar
  10. 10.
    Adams RJ, Nichols FT, Thompson WO (1989) Neurological assessment in acute stroke issue in the use of rating scales. In: Amery WK, Bousser M, Rose FC (eds) Clinical trial methodology in stroke. Tindall, London, pp 54–74Google Scholar
  11. 11.
    Granger CV, Hamilton BB, Gresham GE, Kramer AA (1989) The Stroke Rehabilitation Outcome Study: Part II. Relative merits of the total Barthel Index score and a four-item subscore in predicting patient outcomes. Arch Phys Med Rehabil 70: 100–103PubMedGoogle Scholar
  12. 12.
    Asplund K (1987) Clinimetrics in stroke research. Stroke 18: 528–530PubMedCrossRefGoogle Scholar
  13. 13.
    Shinar D, Gross CR, Bronstein KS, et al (1987) Reliability of the activities of daily living scale and its use in the telephone interview. Arch Phys Med Rehabil 68: 723–728PubMedGoogle Scholar
  14. 14.
    Steiner Ti, Rose FC (1986) Towards a model stroke trial. Neuroepidemiology 5: 121–147PubMedCrossRefGoogle Scholar
  15. 15.
    Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New YorkGoogle Scholar
  16. 16.
    Wood-Dauphinee SL, Williams JI, Shapiro SH (1990) Examining outcome measures in a clinical study of stroke. Stroke 21: 731–739PubMedCrossRefGoogle Scholar
  17. 17.
    Loewen SC, Anderson BA (1988) Reliability of the Modified Motor Assessment Scale and the Barthel Index. Phys Ther 68: 1077–1081PubMedGoogle Scholar
  18. 18.
    Siegel S, Castellan NJ Jr (1992) Nonparametric statistics for the behavioral sciences, 2nd edn. McGraw-Hill, New York, pp 284–291Google Scholar
  19. 19.
    Nunnally JC (1978) Psychometric theory, 2nd edn. McGraw-Hill, New YorkGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1995

Authors and Affiliations

  • P. D. Lyden
    • 1
  • J. Broderick
    • 2
  • E. Mascha
    • 3
  • The NINDS t-PA Stroke Trial Investigators
  1. 1.Departments of Neurology and NeurosciencesUCSD School of Medicine and San Diego Veterans Administration Medical CenterSan DiegoUSA
  2. 2.Department of NeurologyUniversity of Cincinnati Medical CenterCincinnatiUSA
  3. 3.Department of BiostatisticsHenry Ford Hospital and Medical CenterDetroitUSA

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