Evaluating the Modified Barthel Index for Policy and Practice in Reablement: Lessons From Australia's Short‐Term Restorative Care Program

TL;DR

This study evaluates the Modified Barthel Index (MBI) as a tool for measuring outcomes in Australia's reablement care program and finds it has limitations.

Contribution

The study identifies the MBI's ceiling effect and limited utility for guiding program improvements in reablement care.

Findings

The MBI shows significant differences between responders and non-responders, but this may be due to sample size.

The MBI suffers from a ceiling effect, limiting its usefulness for evidence-based program changes.

Future programs should use a range of standardised assessments tailored to participant goals.

Abstract

The Modified Barthel Index (MBI) is the sole reporting metric required by the Australian Government for the Short‐Term Restorative Care program (STRC). This study investigated the suitability of the MBI as an outcome measure of functioning/self‐care ability in the older Australian reablement context.

This was a retrospective cohort study where historical data from 921 participants involved in the STRC between January 2018 to March 2023 were collected from an aged care provider located in Australia. This study compared STRC program responders and non‐responders based on MBI across a range of demographic variables. Additionally, Generalised Linear Modelling was performed to investigate the utility of the MBI to inform changes to the delivery of the intervention.

Although the MBI was able to show significant differences between responders and non‐responders at baseline (p ≤ 0.05), this is likely due to the sample size used. It was identified that the MBI suffers from a ceiling effect in the studied population. Therefore, the ability of the MBI to inform evidence‐based changes relating to program delivery is limited.

This study provides a solid evidence base to guide the implementation of assessments in future programs and studies. This is due to the identification of limitations of the sole reporting metric used in the program. Based on findings throughout this manuscript, a range of standardised assessments dependent on the participant's goals should be implemented in future programs, such as the Restorative Care Pathway in the Support at Home program.

This study highlights the importance of implementing standardised, sensitive and specific assessments in restorative care programs. With the Restorative Care Pathway (RCP) to replace the Short‐Term Restorative Care Program (STRC) in late 2025, findings from the STRC, like those presented in this paper, should inform the implementation of the RCP.

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