Contents hide
Barthel Index
Barthel Index measures the level of disability or dependence of an individual in ten instrumental activities of daily living (mobility, using stairs, dressing, bathing, grooming, feeding, transfer, toileting and bladder and bowel continence) 1. The Barthel Index was developed as a measure to assess disability in patients with neuromuscular and musculoskeletal conditions receiving inpatient rehabilitation 2. The original Barthel Index was scored in steps of five points to give a maximum total score of 100. A widely adopted modified form of Barthel Index by Collin and Wade 3 includes a revised score range of 0–20. Lower Barthel Index scores indicated poorer physical function 4.
Guidelines for use of the Barthel Index are as follows 5:
- Barthel Index should be used as a record of what a patient does, not as a record of what a patient could do.
- The main goal is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason.
- The need for supervision renders the patient not independent.
- A patient’s performance should be established using the best available evidence. The patient, friends/relatives, and nurses are usually asked for the information gathered, but direct observation and common sense are also important. However, direct testing is not needed.
- Usually, the patient’s performance over the preceding 24-48 hours is important, but longer periods are occasionally relevant.
- Middle categories imply that the patient supplies over 50% of the effort.
- Use of aids to be independent is allowed.
Barthel Index key points
- The reliability of the Barthel Index has been investigated in the major clinical settings relevant to older people.
- The Barthel Index was found to be reliable when administered by face-to-face interview and by telephone and on testing by different observers, but has a considerable imprecision.
- The individual studies address different aspects of reliability and use various different statistics, limiting comparability.
- Test–retest reliability has not been investigated on older people with multiple diagnoses.
- A large repeatability study on patients with multiple diagnoses is required to investigate the inter-observer disagreement demonstrated with the Bland and Altman method and to clarify the importance of assessor training.
Barthel Index scoring
Table 1. Modified Barthel Index scale (Barthel Index 100)
| Feeding | |
| Score | |
| 0 | Unable |
| 5 | Needs help cutting or spreading butter, etc, or requires modified diet |
| 10 | Independent |
| Bathing | |
| Score | |
| 0 | Dependent |
| 5 | Independent (or in shower) |
| Grooming | |
| Score | |
| 0 | Needs help with personal care |
| 5 | Independent face/hair/teeth/shaving (implements provided) |
| Dressing | |
| Score | |
| 0 | Dependent |
| 5 | Needs help but can do about half unaided |
| 10 | Independent (including buttons, zips, laces, etc) |
| Bowels | |
| Score | |
| 0 | Incontinent (or needs to be given enemas) |
| 5 | Occasional accident |
| 10 | Continent |
| Bladder | |
| Score | |
| 0 | Incontinent or catheterized and unable to manage alone |
| 5 | Occasional accident |
| 10 | Continent |
| Toilet Use | |
| Score | |
| 0 | Dependent |
| 5 | Needs some help, but can do something alone |
| 10 | Independent (on and off, dressing, wiping) |
| Transfers (Bed to Chair and Back) | |
| Score | |
| 0 | Unable, no sitting balance |
| 5 | Needs major help (one or two people, physical), can sit |
| 10 | Minor help (verbal or physical) |
| 15 | Independent |
| Mobility (On level Surfaces) | |
| Score | |
| 0 | Immobile or < 50 yards |
| 5 | Wheelchair independent, including corners, >50 yards |
| 10 | Walks with help of one person (verbal or physical) >50 yards |
| 15 | Independent (but may use any aid, e.g., stick) >50 yards |
| Stairs | |
| Score | |
| 0 | Unable |
| 5 | Needs help (verbal, physical, carrying aid) |
| 10 | Independent |
| Total score /100 | |
Table 2. Barthel Index scale (Barthel Index 20)
| Mobility indoors | |
| Score | |
| 0 | Immobile |
| 1 | Wheelchair independent (including comers/doors) |
| 2 | Help of one untrained person, including supervision |
| 3 | Independent (may use aid) |
| Transfers | |
| Score | |
| 0 | Unable – no sitting balance, two to lift |
| 1 | Major help: physical help, 1 strong/skilled or 2 normal. Can sit |
| 2 | Minor help: 1 person easily or supervision for safety |
| 3 | Independent |
| Stairs | |
| Score | |
| 0 | Unable |
| 1 | Needs help (verbal/physical, carrying aid) |
| 2 | Independent up and down, carrying walking aid |
| Toilet use | |
| Score | |
| 0 | Dependent |
| 1 | Needs help but can do something (including wiping self) |
| 2 | Independent: can reach toilet/commode, undress, clean self and leave |
| Bladder | |
| Score | |
| 0 | Incontinent or catheterized and unable to manage |
| 1 | Occasional accident (maximum once / 24 hours) |
| 2 | Continent over 7 days |
| Bowels | |
| Score | |
| 0 | Incontinent (or needs to be given enema) |
| 1 | Occasional accident (less than 1 / week) |
| 2 | Continent |
| Bathing | |
| Score | |
| 0 | Dependent |
| 1 | Independent Bath: must get in and out unsupervised, wash self |
| Grooming | |
| Score | |
| 0 | Needs help with personal care |
| 1 | Independent: implement can be provided by helper |
| Dressing | |
| Score | |
| 0 | Dependent |
| 1 | Needs help but can do half unaided |
| 2 | Independent including buttons, zips, laces, etc. |
| Feeding | |
| Score | |
| 0 | Unable |
| 1 | Needs help in cutting up food, spreading butter, etc, but feeds self |
| 2 | Independent (food cooked, served and provided within reach but not cut up. Normal food [not only soft food]) |
| Total score /20 | |
- O’Connell J, Henman MC, Burke É, et al. Association of Drug Burden Index with grip strength, timed up and go and Barthel index activities of daily living in older adults with intellectual disabilities: an observational cross-sectional study. BMC Geriatr. 2019;19(1):173. Published 2019 Jun 24. doi:10.1186/s12877-019-1190-3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591943
- Anita Sainsbury, Gudrun Seebass, Aruna Bansal, John B. Young, Reliability of the Barthel Index when used with older people, Age and Ageing, Volume 34, Issue 3, May 2005, Pages 228–232, https://doi.org/10.1093/ageing/afi063
- Collin C, Wade D. The Barthel Index: a reliability study. IntDisabil Stud 1988; 10: 61–3.
- Reliability of the Barthel Index when used with older people. Sainsbury A, Seebass G, Bansal A, Young JB. Age Ageing. 2005 May; 34(3):228-32.
- Barthel Index. https://emedicine.medscape.com/article/2172491-overview
- Wade DT, Collin C. (1988) The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud. 1988;10(2):64-7.
