Skip to main content


Log in

Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture

Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



To investigate the validity of Barthel Index (BI) compared with de Morton Mobility Index (DEMMI), EuroQol-visual analog scale (EQ-VAS), 2-min walk test (2MWT), and timed get-up-and-go test (TUG), and to evaluate the responsiveness of all outcome measures for assessing functional recovery in older patients who underwent hemiarthroplasty after femoral neck fracture.

Material and method

Eighty-one femoral neck fracture patients who were enrolled in a study evaluating functional recovery after bisphosphonate therapy during 2013 to 2015, and who had data available at both baseline and 12 months after surgery were included in this study.


All scores improved significantly from baseline to the 1-year follow-up. BI had moderate to strong correlation with DEMMI, 2MWT, and TUG (r-value: 0.490–0.843), and mild to moderate correlation with EQ-VAS (r-value: 0.278–0.323). All outcome measurements had high effect estimates. The minimal clinically important difference (MCID) of BI at 12 months was 9.8 points.


Since BI was shown to have good validity (moderate to strong correlation with DEMMI and performance-based tests, and mild to moderate correlation with EQ-VAS), BI can be used to accurately assess functional recovery in patients who undergo hemiarthroplasty after femoral neck fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1


  1. Dhanwal D, Dennison E, Harvey N, Cooper C (2011) Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop 45(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kanis J, Odén A, McCloskey E, Johansson H, Wahl D, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Cooper C, Campion G, Melton L (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289.

    Article  CAS  PubMed  Google Scholar 

  4. Scaf-Klomp W (2001) Recovery of physical function after limb injuries in independent older people living at home. Age Ageing 30(3):213–219.

    Article  CAS  PubMed  Google Scholar 

  5. Post MW, van Asbeck FW, van Dijk AJ, Schrijvers AJ (1995) Dutch interview version of the Barthel index evaluated in patients with spinal cord injuries. Ned Tijdschr Geneeskd 139(27):1376–1380

    CAS  PubMed  Google Scholar 

  6. Houlden H, Edwards M, McNeil J, Greenwood R (2006) Use of the Barthel index and the functional independence measure during early inpatient rehabilitation after single incident brain injury. Clin Rehabil 20(2):153–159.

    Article  PubMed  Google Scholar 

  7. Murcia J, Llorens P, Sánchez-Payá J, Reus S, Boix V, Merino E et al (2010) Functional status determined by Barthel index predicts community acquired pneumonia mortality in general population. J Infect 61(6):458–464.

    Article  PubMed  Google Scholar 

  8. Javier Martín-Sánchez F, Gil V, Llorens P, Herrero P, Jacob J, Fernández C, Miró Ò (2012) Barthel index-enhanced feedback for effective cardiac treatment (BI-EFFECT) study: contribution of the Barthel index to the heart failure risk scoring system model in elderly adults with acute heart failure in the emergency department. J Am Geriatr Soc 60(3):493–498.

    Article  PubMed  Google Scholar 

  9. Unnanuntana A, Laohaprasitiporn P, Jarusriwanna A (2017) Effect of bisphosphonate initiation at week 2 versus week 12 on short-term functional recovery after femoral neck fracture: a randomized controlled trial. Arch Osteoporos 12(1):27.

    Article  PubMed  PubMed Central  Google Scholar 

  10. de Morton N, Davidson M, Keating J (2008) The de Morton mobility index (DEMMI): an essential health index for an ageing world. Health Qual Life Outcomes 6(1):63.

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Morton N, Harding K, Taylor N, Harrison G (2012) Validity of the de Morton mobility index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation. Disabil Rehabil 35(4):325–333.

    Article  PubMed  Google Scholar 

  12. Tidermark J, Zethraeus N, Svensson O, Törnkvist H, Ponzer S (2002) Quality of Life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma 16(1):34–38.

    Article  PubMed  Google Scholar 

  13. Connelly D, Thomas B, Cliffe S, Perry W, Smith R (2009) Clinical utility of the 2-minute walk test for older adults living in long-term care. Physiother Can 61(2):78–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148.

    Article  CAS  PubMed  Google Scholar 

  15. Terwee C, Bot S, de Boer M, van der Windt D, Knol D, Dekker J et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42.

    Article  PubMed  Google Scholar 

  16. Chan YH (2003) Biostatistics 104: correlational analysis. Singap Med J 44(12):614–619

    CAS  Google Scholar 

  17. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  18. Husted J, Cook R, Farewell V, Gladman D (2000) Methods for assessing responsiveness. J Clin Epidemiol 53(5):459–468.

    Article  CAS  PubMed  Google Scholar 

  19. Wright A, Hannon J, Hegedus E, Kavchak A (2012) Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). J Man Manip Ther 20(3):160–166.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jaeschke R, Singer J, Guyatt G (1989) Measurement of health status. Control Clin Trials 10(4):407–415.

    Article  CAS  PubMed  Google Scholar 

  21. Copay A, Subach B, Glassman S, Polly D, Schuler T (2007) Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7(5):541–546.

    Article  PubMed  Google Scholar 

  22. Della Pietra G, Savio K, Oddone E, Reggiani M, Monaco F, Leone M (2011) Validity and reliability of the Barthel index administered by telephone. Stroke 42(7):2077–2079.

    Article  PubMed  Google Scholar 

  23. Morley D, Selai C, Thompson A (2011) The self-report Barthel Index: preliminary validation in people with Parkinson’s disease. Eur J Neurol 19(6):927–929.

    Article  PubMed  Google Scholar 

Download references


The authors gratefully acknowledge Ms. Wachirapan Narktang of the Division of Research, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital and Mr. Suthipol Udompunthurak of the Division of Clinical Epidemiology, Department of Health Research and Development, Faculty of Medicine Siriraj Hospital, for their assistance with data collection and statistical analyses.



Author information

Authors and Affiliations


Corresponding author

Correspondence to Aasis Unnanuntana.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Unnanuntana, A., Jarusriwanna, A. & Nepal, S. Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture. Arch Orthop Trauma Surg 138, 1671–1677 (2018).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: