Content validity of the modified Barthel Index for stroke patients in an African country

Abstract

Background: The Barthel Index is considered the global gold

standard for assessing performance in activities of daily living

(ADL) tasks, but there has been little research undertaken on

this outcome measure for a stroke population in a low to middle

income country. The study aimed to determine the content

validity of the modified Barthel Index (MBI) for assessing the

ADL of stroke patients in an African country.

Method: A mixed methods design using the nominal group

technique was utilised. The study sample consisted of

occupational therapists (n=11) and physiotherapists (n=4) with

four or more years' experience working in the field of adult

neurorehabilitation in South Africa. Each of the four focus

groups analysed the content validity of the MBI using five

questions based on the Table of Specifications methodology.

Data analysis followed van Breda's steps to analysing

multi-group nominal group technique to establish themes

arising from each question and were presented according to

final rank scores.

Results: The findings highlighted aspects of content validity of

the MBI related to language, clarity, content completeness and

appropriateness that require revision.

Conclusion: This study provides recommendations for the

revision of the MBI to improve its content validity for the South

African stroke population.

IMPLICATIONS FOR PRACTICE

• Methodology can be replicated in other multi-cultural and

language countries .

• Training on administration of the MBI can overcome barriers

related to language and item clarity where English is a

healthcare worker's second l?nguage . .

• The MBI is currently most su1tea to environments with water

and sanitation infrastructure

• A future study implementing recommendations for revision of

the MBI for the African stroke populations is suggested