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Exploring rating scale responsiveness

Does the total score reflect the sum of its parts?

From the Neurological Outcome Measures Unit, Institute of Neurology (Drs. O’Connor, Thompson, and Hobart), University College London; Department of Clinical Neuroscience (Dr. Cano), Royal Free & University College Medical School, London; and Department of Clinical Neuroscience (Dr. Hobart), Peninsula Medical School, Derriford Hospital, Plymouth, UK.

Address correspondence and reprint requests to Dr. Jeremy Hobart, Peninsula Medical School, Derriford Hospital, Plymouth PL6 8DH, UK; e-mail: Jeremy.Hobart{at}phnt.swest.nhs.uk

Evaluating rehabilitation requires rating scales that detect change. The authors examined Barthel Index (BI) data from 1,495 patients at a neurorehabilitation unit to determine whether total scale responsiveness accurately reflects item responsiveness. Total score effect sizes were moderate to large (0.47 to 1.09). Item-level effect sizes (0.13 to 1.16) reveal floor (3.5 to 82.3%) and ceiling (9.7 to 95.4%) effects. Results suggest BI total score effect sizes may hide item-level weaknesses and may underestimate the impact of rehabilitation.

Received September 30, 2003. Accepted in final form December 10, 2003.

See also page 1666

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