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Measuring nursing needs of stroke patients in clinical rehabilitation: a comparison of validity and sensitivity to change between the Northwick Park Dependency Score and the Barthel Index

J MA Visser-Meily

Rehabilitation Centre De Hoogstraat, Utrecht and Institute for Rehabilitation Research, Hoensbroek, The Netherlands

L SF Gispen

Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands

Objective: To compare the content and convergent validity and the sensitivity to change of the Northwick Park Dependency Score (NPDS) to that of the Barthel Index in patients with stroke.

Setting: Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.

Design: Inclusion of consecutive patients with stroke. Measurements at admission and every four weeks until "nal measurement at discharge. Administration by nurses of NPDS, Barthel Index and nurses' global ratings of nursing dependency.

Results: Thirty-one patients were included and 123 measurements were obtained. Median Barthel Index scores at admission and discharge were 11.2 and 17.8 respectively. At discharge, 58.6% of all patients obtained the best possible Barthel Index score, against 31.1% for the Basic Care Needs section and 87.1% for the Special Nursing Needs sections of the NPDS. Spearman correlations between NPDS and Barthel Index were very strong (0.82–0.92) at each measurement. Both the NPDS and the Barthel Index showed strong relationships with the global rating of nursing dependency (–0.82 and 0.70 respectively) and showed good sensitivity to change, Z-values for differences between admission and discharge were 4.06 (p < 0.001) for the NPDS and 4.20 (p < 0.001) for the Barthel Index. Most (9/12) nurses involved in this study judged the NPDS to provide better, more precise and complete information about the actual need for care of the patients.

Conclusions: Validity and sensitivity to change of the NPDS were not superior to those of the Barthel Index but most nurses preferred the NPDS for future use.

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