Objective: To establish the structural validity of the Chinese version of the Modified Barthel Index and to estimate its inter-rater reliability for use with patients who have had a stroke. Design: Prospective study. Setting: A regional general hospital and a day hospital in Hong Kong. Subjects: One hundred and sixteen older people who had had a stroke (mean age 76.0; SD 7.6) were involved in the establishment of evidence of the structural validity and item quality. Another 15 older people with stroke (mean age 78.0; SD 7.1) participated in estimating the reliability of the instrument. Methods and results: The Modified Barthel Index was translated into Chinese. Factor analyses revealed a two-factor structure that explained 75.7% of the total variance. Factor 1 was found to consist of eight items relating to patients' functional performance. Factor 2 consisted of the two items that focused on patients' `physiological needs'. The test—retest reliability of the Chinese version at the item level was comparable with that of the original version, with kappa statistics ranging from 0.63 to 1.00 (P < 0.001). Conclusion: The Chinese version of the Modified Barthel Index (MBI-C) seems to be valid and reliable for use with older people with stroke. Changes were made to the item content and the rating criteria that were specific to Chinese culture. The structural validity and the reliability of the Chinese version were shown to be robust across the original and Chinese groups.

Objective To systematically examine the incidence of cognitive impairment in individuals with spinal cord injury (SCI), as well as identify potential contributing and confounding factors. Methods Studies quantitatively reporting cognitive ability after spinal cord injury were searched electronically via Medline, CINAHL, Embase, and PsycINFO. Manual screening for references within articles was also performed. A total of 2,481 studies were screened and a total of 70 were included in this review, 21 reporting cognitive function after SCI compared to an able-bodied control group and 49 with no able-bodied controls. Studies were analyzed for the incidence of impairment and the interactions with concomitant traumatic brain injury, psychological or somatic complaints, decentralized cardiovascular control, sleep apnea, neurologic level of injury, and age. Results There is a high volume of evidence reporting substantial cognitive impairment in individuals with SCI. Potential co-contributors include concomitant brain injury, psychological or somatic comorbidities, decentralized cardiovascular control, and sleep apnea. Cognitive functioning was negatively correlated with age. No clear agreement was found for the incidence of cognitive impairment or its association with level of injury. Conclusion Current evidence suggests that individuals with SCI should be examined and addressed for cognitive impairment. Future studies aimed at identifying potential secondary causative factors should employ stringent controls for co-occurring brain trauma since it appears to be a major contributor and confounder to impaired cognition.