Effects of Physical Therapy on Item-by-Item Changes in Barthel ADL Index Among Stroke Patients in Yasothon Province

Abstract

Purposes: To compare the total scores, analyze item-specific changes, and identify statistically significant improvements in the Barthel ADL Index, as well as to examine the relationship between patients' clinical characteristics and changes in individual Barthel ADL items.

Study design: This was a quasi-experimental study using a one-group pretest–posttest design.

Materials and Methods: The sample consisted of 40 stroke patients who met the inclusion criteria, selected via purposive sampling. Data were collected using the Thai version of the Barthel Index of Activities of Daily Living (BI). Statistical analysis included frequency, percentage, mean, standard deviation, paired-sample t-test, percentage differences, and Pearson’s correlation coefficient. The statistical significance level was set at a 95% confidence interval.

Main findings: Following the rehabilitation program, stroke patients demonstrated statistically significant improvements across all components (p < .001). The total BI score increased from 7.27 ± 5.25 to 16.77±3.87$, representing a mean difference of 9.50 points (95% CI: 7.84, 11.15). Item-wise analysis revealed that "Mobility" showed the greatest improvement, with a mean difference of 2.30points (95% CI: 2.04, 2.56). Although "Grooming" and "Bowel control" showed the least improvement, the changes remained statistically significant. Comparison of individual Barthel ADL items showed an overall mean score increase of 92.46%. Clinical characteristics were positively correlated with item-specific changes at a moderate level (r = 0.55, p = .019). Assessment using the Chula ADL Index (CAI) showed that while 97.5 of participants were dependent at baseline, the proportion of those achieving full independence (score of 9) increased significantly from 2.5 to 35.0 by the fourth phase of the study a 14-fold increase. Consequently, the number of dependent patients decreased steadily from 39 to 26 cases by the end of the study.

Conclusion and Recommendations: The rehabilitation program led to statistically significant improvements in all components of patient recovery. Total Barthel ADL scores more than doubled, with "Mobility" being the most prominent area of development. While grooming and bowel control showed relatively smaller gains, the progress remained clear and significant.