Investigation of Minimal Clinically Important Difference of the Extended Barthel Index in Inpatients With Acute to Subacute Stroke in China.

Hong Kong journal of occupational therapy : HKJOT · 2026 · Cohort · OT
Yue Sun, Ying Sun, Jiajia Shi

In stroke inpatients, a 4-point gain on the 64-point Extended Barthel Index is the smallest improvement a patient notices; 6 points is what a family member would call meaningful. A 2-point drop is what a therapist would call slight decline.

Key findings

1

Using the anchor-based method (which the authors recommend for clinical use), the smallest EBI score gain a patient would register as improvement was 4.0 points, an occupational therapist 4.5 points, and a family member acting as payer 6.0 points. For deterioration, the thresholds were −2.0 (OT), −1.0 (patient), and 0 (payer) points.

2

The mean EBI score rose from 37.96 to 42.99 over 4 weeks of standard post-stroke rehabilitation, a statistically significant change (p < .001).

3

The ROC curve method produced area-under-curve values above 0.99 for all three rater groups, but specificity was 0.0% (OT), 3.8% (patient), and 4.5% (payer), meaning almost every patient the rater called 'not improved' still had a score gain above the derived cutoff.

MethodologyResultsClinical Relevance

Single-blind randomized controlled trial. Sixty-four participants were randomized across two intervention arms and assessed at twelve weeks for the primary outcome…

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