Validation of the Barthel Index in Chinese nursing home residents: an item response theory analysis

Minyu Liang; Mei Yin; Bing Guo; Yichao Pan; Tong Zhong; Jieyi Wu; Zengjie Ye

doi:10.3389/fpsyg.2024.1352878

Validation of the Barthel Index in Chinese nursing home residents: an item response theory analysis

Front Psychol. 2024 Apr 30:15:1352878. doi: 10.3389/fpsyg.2024.1352878. eCollection 2024.

Authors

Minyu Liang¹, Mei Yin², Bing Guo², Yichao Pan³, Tong Zhong⁴, Jieyi Wu¹, Zengjie Ye⁵

Affiliations

¹ School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.
² Assisted Living Facility, Home For The Aged Guangzhou, Guangzhou, China.
³ Department of Vasculocardiology, Guangzhou First People's Hospital, Guangzhou, China.
⁴ Department of Tumor Radiotherapy, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China.
⁵ School of Nursing, Guangzhou Medical University, Guangzhou, China.

Abstract

Background: The Barthel Index (BI) is used to standardize the grading of assessments for clinical needs, insurance support, and long-term care resource allocation in China. However, its psychometric properties among nursing home residents remain unclear. Therefore, this study aims to assess and modify the psychometric properties of BI in nursing home residents.

Methods: A total of 1,402 individuals undergoing evaluation in a nursing home facility in China were included in this study from November 2021 to November 2022. Correlations between items were examined to identify the potential multicollinearity concerns. The unidimensional item response theory (IRT) was used to validate and modify the single structure of BI. Furthermore, the logistic regression/IRT hybrid DIF detection method was conducted to assess differential item functioning (DIF) between the dementia group and the normal group.

Results: The pairing of items 5 ("bowl control") and 6 ("bladder control") revealed a local dependence issue, leading to their consolidation. Items 56 (bowel and bladder control) and 9 (mobility) both displayed poor fit indices and underwent category collapsing. Through the application of the generalized partial credit model, the adjusted scale displayed better fit indices, demonstrating a robust discriminative power (DC >1.5) and orderly thresholds. Furthermore, non-uniform DIF was identified in item 2 (bathing) between the dementia group and the normal group.

Conclusion: The modified BI demonstrated favorable psychometric properties and proved to be suitable for evaluating nursing home residents experiencing moderate functional impairment, which may provide a precise evaluation for long-term care resource allocation. Future studies could explore integrating supplementary measurements, such as objective indices, to assess a broader spectrum of functional statuses to potentially enhance the limited precision width observed in BI.

Keywords: Barthel Index; differential item functioning; item response theory; nursing home residents; psychometric properties.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.