ORIGINAL RESEARCH article
Front. Aging
Sec. Healthy Longevity
Determining the Optimal Barthel Index Cutoff Scores for Predicting Longshi Scale Grades Across Age Groups in Stroke Patients
Provisionally accepted
- 1Department of Rehabilitation, Shenzhen Second People’s Hospital, Shenzhen, China
- 2Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
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Background: The Barthel Index (BI) is a standard, widely used measure of dependence in activities of daily living (ADL), particularly in stroke care. The Longshi Scale (LS) offers a simpler, more user-friendly alternative, yet it lacks a validated, age-stratified mapping to BI scores. This gap limits consistent outcome interpretation and application. Objective: To establish and validate a standardized, age-stratified concordance between BI scores and LS grades, thereby providing a practical conversion tool for clinical and research settings. Method: In a multi-center study of 16,412 stroke inpatients (3 months post-stroke), BI scores and LS grades were analyzed across age groups: <60 years (n=12,662), 60-79 years (n=2,596), and ≥80 years (n=1,154). Sensitivity (correct identification) and specificity (correct exclusion), along with receiver operating characteristic (ROC) curves were used to determine optimal BI cutoff points for each LS grade. Spearman correlation and Kruskal-Wallis test were applied to different age groups. Results: Key BI cutoffs were identified for LS grades: ≥75 for LS≥2, ≥45 for LS≥4, and <5 for LS=6. These key values were consistent across different age groups. The BI score was negatively correlated with LS disability level (e.g., r = -0.879 for ≥80 years, p<0.001). Correlations remained strongest at severe disability levels (LS Grades 5-6) across age groups (r = -0.60 to -0.65). AUC analysis demonstrated excellent discriminative ability, especially for the mildest (LS 1) and most severe (LS 6) disability levels (AUC > 0.95). Conclusion: The study provides age-stratified BI cutoff values to guide resource allocation, emphasizing the need to prioritize care for individuals aged ≥80 years with BI scores below 5.
Keywords: ADL, barthel index, Cutoff score, Disability, ROC Curve
Received: 09 Sep 2025; Accepted: 16 Jan 2026.
Copyright: © 2026 Zhang, Zhou, Liu, Ye and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yulong Wang
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