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




Nominal group technique, Occupational Therapy Practice Framework (OTPFIII), Functional Independence Measure (FIM), Neurorehabilitation, Activities of daily living


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 language. • The MBI is currently most suited to environments with water and sanitation infrastructure. • A future study implementing recommendations for revision of the MBI for the African stroke populations is suggested.


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How to Cite

Breytenbach, F. C., Freeme, J. D., de Witt, P. A., & Franzsen, D. (2023). Content validity of the modified Barthel Index for stroke patients in an African country. South African Journal of Occupational Therapy, 53(3), 3–12.



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