Development of a Barthel Index based on dyspnea for patients with respiratory diseases

Figures & data

Table 1 Baseline characteristics of the 169 studied patients

Variable	Mean (SD)
BMI	27.91 (6.76)
CIRS1	1.66 (0.46)
CIRS2	2.93 (1.71)
FEV1, % predicted	58 (27)
FVC, % predicted	82 (23)
FEV1/FVC, %	72 (25)
GOLD stages in patients with COPD, n (%)
GOLD I: 11 (8.1)
GOLD II: 31 (22.8)
GOLD III: 31 (22.8)
GOLD IV: 63 (46.32)
pH	7.43 (0.05)
PaCO2, mmHg	45 (27)
PaO2/FiO2	314 (61)
6MWD, m	279 (143)
Barthel Index (score)	94 (14)
CRF, n (%)	69 (41)
Diagnosis	n (%)
COPD	136 (80)
Restrictive lung disease*	20 (12)
ILD	4 (2)
Other	9 (6)
Pharmacotherapy	n (%)
None	33 (19)
LAMA	15 (9)
LABA + LAMA	45 (27)
LABA + LAMA + ICS	76 (45)
LTOT	69 (41)

Note:

* 2 ILD and 18 chest wall disease.

Abbreviations: BMI, body mass index; CIRS, Cumulative Illness Rating Scale; COPD, chronic obstructive pulmonary disease; CRF, chronic respiratory failure; FEV₁, forced expiratory volume in 1 second; FiO₂, inspiratory fraction of oxygen; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Diseases; ICS, inhaled corticosteroid; ILD, interstitial lung diseases; LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist; LTOT, long-term oxygen therapy; 6MWD, 6-minute walk distance; PaCO₂, arterial partial pressure of carbon dioxide; PaO₂, arterial partial pressure of oxygen; SD, standard deviation.

Figure 1 Correlation between meters at 6MWD and the BI-d scale.

Abbreviations: BI-d, Barthel Index-dyspnea; 6MWD, 6-minute walking distance.

Figure 2 Box plot of distribution of BI-d according to MRC dyspnea score grading (0–4) measured at baseline.

Notes: Statistical significance (P<0.001) was found among MRC dyspnea score grading groups; statistical significance (P<0.01) was found between MRC grade 4 and all the other MRC grading groups.
Abbreviations: BI-d, Barthel Index-dyspnea scale; MRC, Medical Research Council.

Figure 3 Mean distribution of each BI-d item at admission (dark line) and discharge (gray line).

Note: *P<0.001 over time.
Abbreviation: BI-d, Barthel Index-dyspnea.

Table 2 Median assessed at the beginning (T0) and at the end (T1) of the rehabilitative program using the two indexes BI and BI assessing dyspnea perception (BI-d) in the two subgroups (no CRF vs yes CRF)

	No CRF		Delta (%)	Yes CRF		Delta (%)
	T0	T1		T0	T1
BI score	98	100	+2	97	98	+2
BI-dyspnea score	14	7	−50	27	15	−50
MRC score	2	2	0	3	2	−33
6MWD, meters	315	390	+24	225	300	+33

Abbreviations: BI, Barthel Index; BI-d, Barthel Index dyspnea; CRF, chronic respiratory failure; MRC, Medical Research Council; 6MWD, 6 minute walk distance.

Table S1 BI-d

Items	Assessment
Options	0	1	2	3	4
Grooming	0	1	3	4	5
Bathing	0	1	3	4	5
Feeding	0	2	5	8	10
Toilet use	0	2	5	8	10
Stairs	0	2	5	8	10
Dressing	0	2	5	8	10
Bowels	0	2	5	8	10
Bladder	0	2	5	8	10
Mobility	0	3	8	12	15
Wheelchair*	0	1	3	4	5
Transfers (bed to chair and back)*	0	3	8	12	15

Notes:

* Not to be filled in if the patient is able to walk. Answer options: 0= no sign of dyspnea during execution of ADLs; 1= slight dyspnea that does not prevent or slow down execution of ADLs; 2= moderate dyspnea, which can slow down ADLs; 3= severe dyspnea, which can greatly slow down ADLs; 4= extremely severe level of dyspnea, such as to preclude or reduce that activity.

Abbreviations: ADLs, activities of daily living; BI-d, Barthel Index-dyspnea.