Quality of Life Research

, Volume 28, Issue 12, pp 3177–3185 | Cite as

Mapping the Shah-modified Barthel Index to the Health Utility Index Mark III by the Mean Rank Method

  • Yin Bun CheungEmail author
  • Hui Xing Tan
  • Nan Luo
  • Hwee Lin Wee
  • Gerald C. H. Koh



To map the Shah-modified Barthel Index (SBI) to the Health Utility Index Mark III (HUI-3) in stroke patients, and to compare the performance of a recently developed method called the Mean Rank Method (MRM) against a popular method, the Ordinary Least Squares (OLS) method.


A cohort of 473 patients who had their first clinical stroke diagnosis and hospital admission and were assessed using the SBI and HUI-3 at 3 months and/or 12 months post-admission. Observations were split to form a training dataset (N = 473) and a validation dataset (N = 245).


In the training dataset, the MRM using SBI total score as the predictor produced a mapped utility distribution that closely resembled the observed utility distribution. It had almost no shrinkage of the standard deviation (P = 0.542), whereas the OLS using SBI total score and SBI item scores under-estimated the standard deviation by 28% and 26%, respectively (each P < 0.001). The MRM mapping gave better fit in terms of smaller mean absolute error and larger intra-class correlation than the two versions of OLS mapping, whereas the OLS gave smaller mean-squared errors than the MRM. Multivariate regression analysis showed that the use of OLS-mapped utilities tended to under-estimate both the mean utility of people who had no comorbidity and the utility-comorbidity association as compared to the observed utility-comorbidity pattern although the differences did not reach statistical significance (each P > 0.05). The MRM-mapped utility showed utility-comorbidity pattern more similar to the observed. Similar findings were obtained from the validation dataset.


The MRM performed well. Mapping functions are available to map the SBI to the HUI-3 Utility Index.


Activities of daily living Barthel Index Health utility Health Utility Index Mark III Mapping Stroke 


Author contributions

Conceptualization: YBC, NL, and HLW and GCHK. Data analysis: YBC and HXT. Writing, original draft: YBC and HXT. Writing, critical review and final version: HXT, YBC, NL, and HLW, GCHK.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no potential conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (National University of Singapore Institutional Review Board S17-257E) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2019_2254_MOESM1_ESM.xls (38 kb)
Supplementary material 1 (XLS 38 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Program in Health Services & Systems Research and Centre for Quantitative MedicineDuke-NUS Medical SchoolSingaporeSingapore
  2. 2.Centre for Child Health Research, Tampere UniversityTampereFinland
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  4. 4.Department of PharmacyNational University of SingaporeSingaporeSingapore

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