Vol. 2 No. 01 (2026): Journal of Sports Nursing, Medical, And Health (JSNMH)
Original Research Articles

Translation, Validation, and Cultural Adaptation of The Barthel Index Questionnaire in Patients with First-Time Ischemic Stroke

Salbila Nurngazizath Sudirman
Fakultas Farmasi, universitas Bakti Tunas Husada
Ilham Alifiar
Fakultas Farmasi, Universitas Bakti Tunas Husada, Tasikmalaya, Jawa Barat
Nur Rahayuningsih
Fakultas Farmasi, Universitas Bakti Tunas Husada, Tasikmalaya, Jawa Barat

Published 2026-01-31

Keywords

  • Barthel Index,
  • Ischemic Stroke,
  • Reliability,
  • Validity

How to Cite

Sudirman, S. N., Alifiar, I., & Rahayuningsih, N. (2026). Translation, Validation, and Cultural Adaptation of The Barthel Index Questionnaire in Patients with First-Time Ischemic Stroke. Journal of Sports Nursing, Medical, And Health, 2(01), 26–41. https://doi.org/10.69606/sportnursmedhealth.v2i01.442

Abstract

Background: Ischemic stroke is one of the leading causes of long-term functional disability, requiring accurate assessment of a patient’s ability to perform activities of daily living. The Barthel Index is a widely used instrument for evaluating functional independence. However, culturally adapted version in both Indonesian and Sundanese languages have not yet been developed for stroke patients in the Tasikmalaya region. Aim:  This study aimed to conduct the translation, cultural adaptation, and validate of the Barthel Index questionnaire in patients experiencing their first ischemic stroke. Methods: An observational study with a cross-sectional design was conducted involving 40 respondents at KHZ Mustofa Hospital, Tasikmalaya. The translation process employed a forward-backward translation method by professional translators, followed by expert reviews and cultural adaptation through panel discussions. Validity testing was performed using criterion validity and construct validity based on Structural Equation Modeling (SEM), while reliability testing used Cronbach's Alpha. Results:  The results showed path coefficient values ≥ 0.5 and t-statistics > 1.96, indicating strong construct validity. Cronbach's Alpha was 0.870, reflecting high internal consistency. The model also demonstrated acceptable Average Variance Extracted (AVE ≥ 0.5) and Composite Reliability (CR ≥ 0.7). Conclusion:  These findings confirm that the Indonesian and Sundanese versions of the Barthel Index are valid and reliable instrument for assessing the functional independence of ischemic stroke patients the local cultural context. This instrument is expected to support clinical decision-making and further research in hospital pharmacy and rehabilitation settings.

References

  1. Achmad, syahlani +, & Desy Setyorini. (2023). Pengujian Secara Empiris (Uji Validitas dan Reliabilitas) Instrumen Minat Belajar Matematika Siswa. https://doi.org/:https://j-innovative.org/index.php/Innovative
  2. Alifiar, I., Kamal, H. F., & Sukmawan, Y. P. (2021). The effect of aspirin therapy on the increasing of Barthel Index score in stroke patients. Pharmacy Reports, 1(2), 3. https://doi.org/10.51511/pr.3
  3. Alifiar, I., Perwitasari, D. A., Amalia, L., & Affandi, I. G. (2025). Translation, Adaptation, and Validation of the Barthel Index for Ischemic Stroke Patients in the West Java Population, Indonesia. The Open Public Health Journal, 18(1). https://doi.org/10.2174/0118749445389275250602062049
  4. Astuti, F., Capritasari, R., Iskardyani, D., Alifiar, I., & Muhammad Irham. (2023). Identifikasi Variasi Dan Ekspresi Gen Pada Stroke Iskemik Dengan Pendekatan Bioinformatika.
  5. Baskara, Z. W., Putri, D. E., & Purnamasari, N. A. (2024). Pemodelan Umur Harapan Hidup di Provinsi NTB dengan menggunakan SEM-PLS. Mandalika Mathematics and Educations Journal, 6(2), 785–797. https://doi.org/10.29303/jm.v6i2.8261
  6. Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. In SPINE (Vol. 25, Issue 24).
  7. Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reliability study. International Disability Studies, 10(2), 61–63. https://doi.org/10.3109/09638288809164103
  8. Dian Saraswati, R., & Khariri. (2021). Transisi Epidemiologi Stroke sebagai Penyebab Kematian pada Semua Kelompok Usia di Indonesia. In Seminar Nasional Riset Kedokteran (SENSORIK II.
  9. dos Reis, N. F., Biscaro, R. R. M., Sarmento Figueiredo, F. C. X., Lunardelli, E. C. B., & da Silva, R. M. (2021). Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. Revista Brasileira de Terapia Intensiva, 33(3), 353–361. https://doi.org/10.5935/0103-507X.20210051
  10. Eko Aprilianto Handoko, Zulfahmi Muslim, & Laila Rizqi Kurniawan. (2025). Profile Pasien Stroke di RS Bhayangkara Bondowoso Tahun 2024. https://doi.org/:10.46799/syntaxidea.v7i3.12722
  11. Fakhri Ramadhan, M., Siroj, R. A., Win Afgani, M., Raden Fatah Palembang, U., H Zainal Abidin Fikri, J. K., Kemuning, K., Palembang, K., & Selatan, S. (2024). Validitas and Reliabilitas. Journal on Education, 06(02), 10967–10975.
  12. Ferdiani, R. D., & Harianto, W. (2024). Uji Validitas Dan Reliabilitas Instrumen E-Modul Berbasis Microlearning Dengan Strategi Project Based Learning Untuk Meningkatkan Kemampuan Berpikir Kreatif Siswa Penyandang Tuna Rungu. Fakultas Sains Dan Teknologi-Universitas PGRI Kanjuruhan Malang, 6(1). https://doi.org/10.21067/jtst.v6i1.9839
  13. Galeoto, G., Berardi, A., & Castiglia, S. F. (n.d.). Evaluation of the psychometric properties of the Barthel Index in an Italian ischemic stroke population in the acute phase: a cross-sectional study. https://www.researchgate.net/publication/333665519
  14. Harith, S., & Tan, S. L. (2020). Translation and validation of the malay version of comprehensive geriatric assessment questionnaire for older adults in Malaysia. Annals of Geriatric Medicine and Research, 24(2), 115–124. https://doi.org/10.4235/AGMR.20.0005
  15. Ingarianti, T. M., Suhariadi, F., & Fajrianthi, F. (2022). Adaptasi alat ukur kesuksesan karier subjektif. Jurnal Ilmiah Psikologi Terapan, 10(1), 300–309. https://doi.org/10.22219/jipt.v10i1.19002
  16. Lee, E. Y., Sohn, M. K., Lee, J. M., Kim, D. Y., Shin, Y. Il, Oh, G. J., Lee, Y. S., Lee, S. Y., Song, M. K., Han, J. H., Ahn, J. H., Lee, Y. H., Chang, W. H., Choi, S. M., Lee, S. K., Joo, M. C., & Kim, Y. H. (2022). Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. International Journal of Environmental Research and Public Health, 19(15). https://doi.org/10.3390/ijerph19159612
  17. Mather, Rahayu, H. Amandus, sudarto, & irma triyani. (2024). Activity Of Daily Living dan Kualitas Hidup Pasien Pasca Stroke Iskemik. Jurnal Keperawatan Dan Kesehatan, 15(1), 1–12. https://doi.org/10.54630/jk2.v15i1.320
  18. Nissa Asri Reza Wardaningtyas, & Suwendar. (2025). Hubungan Tingkat Pengetahuan Pasien terhadap Penyakit Diabetes dan Kepatuhan Penggunaan Antidiabetes di Puskesmas Kalipucang Kabupaten Pangandaran. Bandung Conference Series: Pharmacy, 5(1), 37–46. https://doi.org/10.29313/bcsp.v5i1.16679
  19. Nur Amalia, R., Setia Dianingati, R., & Annisaa, E. (2022). Pengaruh Jumlah Responden Terhadap Hasil Uji Validitas dan Reliabilitas Kuesioner Pengetahuan dan Perilaku Swamedikasi. Generics : Journal of Research in Pharmacy Accepted : 4 Mei, 2(1).
  20. nurhaswinda, meynita pratasya, laila qurrotun, risma tri nada, neftihana, sepni, ulia, ahmad mauluddin, sahrani taskia, & vini. (2025). PENELITIAN KORELASI. 4. https://doi.org/https://publisherqu.com/index.php/pediaqu
  21. Oviantara, A. T., & Kasmawati, Y. (2024). Peran Motivasi Kerja dalam Memediasi Pengaruh Lingkungan Kerja dan Disiplin Kerja Terhadap Kinerja Pegawai Negeri Sipil (PNS) Pada Biro SDM Sekretariat Jenderal Kemendikbudristek. In ProBusiness: Management Journal (Vol. 15, Issue 4). www.jonhariono.org/index.php/ProBisnis
  22. Ozcan Kahraman, B., Ozsoy, I., Kahraman, T., Tanriverdi, A., Acar, S., Ozpelit, E., Akdeniz, B., Hiser, S., Guimaraes, F. S., Needham, D. M., & Savci, S. (2020). Turkish translation, cross-cultural adaptation, and assessment of psychometric properties of the Functional Status Score for the Intensive Care Unit. Disability and Rehabilitation, 42(21), 3092–3097. https://doi.org/10.1080/09638288.2019.1602852
  23. Permatasari, N. (2020). The Comparison of Non-Hemorrhagic Stroke with Motor Disorders Patients Have Risk Factors for Diabetes Mellitus and Hypertension. Juni, 11(1), 298–304. https://doi.org/10.35816/jiskh.v10i2.273
  24. Rosanti, E., Alifiar, I., Salasanti, C. D., Studi, P., Universitas, F., Tunas, B., & Tasikmalaya, H. (2024). Analisis Kejadian Stroke Berulang pada Pasien yang Menggunakan Antiplatelet di RS X Kota Tasikmalaya. In Jurnal Ilmu Farmasi (Vol. 15, Issue 2).
  25. Shah, S., & Cooper, B. (1989). Improving The Sensitivity Of The Barthel Index For Stroke Rehabilitation (Vol. 42, Issue 8).
  26. Siti nurdiyanah, nia kurniasih, & ahmad mubarak. (2024). Identification of Variable Indicators that Influence Relationship Between Extension Worker Characteristics, Farmer Characteristics, Extension Worker Performance, and Changes in Farmers Behavior.
  27. Terwee, C. B., Bot, S. D. M., de Boer, M. R., van der Windt, D. A. W. M., Knol, D. L., Dekker, J., Bouter, L. M., & de Vet, H. C. W. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012
  28. Wisastry, S., Alifiar, I., & Dewi Salasanti, C. (2024). Analisis Kejadian Stroke Berulang Pada Pasien Ynag Menggunakan Antiplatelet di Rumah Sakit X Ciamis. In JFL Jurnal Farmasi Lampung (Vol. 13, Issue 2).