Reliability of a short questionnaire for the diagnosis of severe disability in polypathological patients attended in hospital setting |
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| Authors: | Javier Galindo-Ocaña Máximo Bernabeu-Wittel Manuel Ollero-Baturone Bosco Barón-Franco José Manuel Murcia-Zaragoza Antonio Fernández-Moyano Jesús Díez-Manglano Lourdes Moreno-Gaviño |
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| Institution: | 1. Internal Medicine Department, Hospital Universitario Virgen del Rocío, Seville, Spain;2. Internal Medicine Department, Hospital Juan Ramón Jiménez, Huelva, Spain;3. Internal Medicine Department, Hospital General de Alicante, Spain;4. Internal Medicine Department, Chief of Medical Area, Hospital de Bormujos, Seville, Spain;5. Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain;1. Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy;2. Dipartimento di Farmacia, Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy;3. Dipartimento di Area Critica Medico Chirurgica, Università degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy;1. Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy;2. Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy;1. Pharmaceutical Department, Local Health Unit of Verona, Via Salvo D''Acquisto 7, 37122 Verona, Italy;2. Health Care Systems Department, CINECA — Consortium of Universities, Via Magnanelli 6/3, 40033 Casalecchio di Reno (BO), Italy;3. Department of Cardiac Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy;1. Internal Medicine Service, University Hospital of Gran Canaria Dr. Negrin, Las Palmas, Spain;2. Internal Medicine Service, University Hospital Bellvitge, L''Hospitalet de Llobregat, Barcelona, Spain;3. Internal Medicine Service, University Hospital Vall d'' Hebron, Barcelona, Spain;4. Internal Medicine Service, Hospital de Girona Josep Trueta, Girona, Spain;5. Internal Medicine Service, Hospital Monte San Isidro, León, Spain;6. Internal Medicine Service, Hospital Nuestra Señora de Sonsoles, Ávila, Spain;7. Internal Medicine Service, Hospital Royo Villanova, Zaragoza, Spain;8. Internal Medicine Service, University Hospital Reina Sofía, Córdoba, Spain;1. Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;2. Charité-Universitätsmedizin, Campus Virchow-Klinkum, Department of Internal Medicine–Cardiology, Berlin, Germany;3. Clinical Center Ni?, Department of Cardiology, Ni?, Serbia;4. Department of Internal Medicine–Cardilogy, University of Göttingen, Germany;5. Zvezdara University Medical Center, Department of cardiology, Belgrade, Serbia;6. Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;7. Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany;1. Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'' Andrea delle Fratte, 06156, Perugia, Italy;2. Stroke Unit and Division of Neurology, Ospedale “C. Poma”, Strada Lago Paiolo 10, 46100, Mantua, Italy |
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| Abstract: | BackgroundA comprehensive evaluation of polypathological patients (PP) should always include a functional evaluation. For this purpose, a modified version of the Barthel Index (BI) is the most applied questionnaire, and it consists of a 10-variable scale. The aim of this study was to develop a screening and confirmation tool to diagnose high disability with the fewest number of dimensions of the BI as possible.MethodThis present cross-sectional observational multicentre study included PP attended in 36 Spanish hospitals that were divided into two geographical areas (Western and Eastern). The Western area was considered to be the derivation subgroup of PP, and the Eastern area was the validation subgroup. Complete disability for each item (value of 0) was assessed for the diagnosis of severe disability. Diagnostic validity indices (sensitivity, specificity, negative and positive predictive values NPV and PPV, respectively], and negative and positive likelihood ratios NLR and PLR, respectively]) were determined for the derivation subgroup. The dimensions with the best diagnostic validity indices were then used to evaluate the validation subgroup.ResultsThe analysis included 1521 PP, 753 PP from the Western area and 768 PP from the Eastern area. Needing complete help for bathing showed the highest NPV and lowest NLR in the derivation/validation subgroups (NPV 96.87/95.54, NLR 0.07/0.13). Being disabled for feeding alone showed high PPV and PLR values (PPV 97.97/95.65, PLR 109.25/49.62), as did disability for transfers (PPV 98.48/97.96, PLR 143.36/107.68). In addition, complete disability for feeding and transfers had the best PPV and PLR in both subgroups (PPV 100/100, PLR X/0).ConclusionsA two-dimension mini-Barthel Index may represent a reliable diagnostic test for severe disability in PP. |
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