Measuring the outcomes of day hospital attendance: a comparison of the Barthel Index and London Handicap Scale

Objective: To assess the ability of two scales to measure the effects of attendance at a geriatric day hospital. Design: 'Before-and-after' measurements. Setting: Day hospital serving a defined, urban, catchment area. Subjects: One hundred and three consecutive new patients over a three-month period. Intervention: Day hospital attendance for as long as the multidisciplinary team thought warranted. Outcome measures: Barthel Index and London Handicap Scale. Results: Seventy-six patients (74%) attended for broadly defined 'rehabilitation'. Measurements on the Barthel Index and London Handicap Scale were completed on 54 of these. Repeat measurements after discharge from the day hospital were achieved on 37 patients. Patients attended between two and 57 times, with a median of eight. Mean Barthel Index did not change over the period of attendance. There was a small improvement in mean handicap score. Eight patients were identified post hoc who attended for 10 or more sessions, and they experienced a large mean reduction in handicap. Conclusion: Overall, neither the Barthel Index nor the London Handicap Scale changed much during attendance at the day hospital. Generally very short lengths of attendance may have explained this. For patients with more prolonged attendance, who might be expected to change more, the London Handicap Scale proved more responsive than the Barthel Index.