The Barthel Index

The Barthel Index is one of the oldest developed measures of ADLs. It was originally developed to assess the severity of disability in personal care and mobility in stroke patients (Mahoney & Barthel 1965).

ItemScoring
  • Bathing
  • Grooming
  • Feeding
0=dependent; 5=independent
  • Dressing
  • Toilet use
  • Ascend/descend stairs
0=dependent; 5=needs help; 10=independent
  • Bowel management
  • Bladder management
0=dependent; 5=occasional accident; 10=independent
  • Bed/wheelchair transfer
0=unable, 5=major help needed; 10= minor help; 15=independent
  • Mobility (level surface)
0=unable; 5=wheelchair >50yards; 10=walks >50 yards; 15=independent

 

Number of items: 10

Procedure/Administration: Scores are obtained using direct observation, self-report, or responses from family/friends. Scores based on the past 48 hours are preferred.

How scored: Total scores are calculated by summing the individual item scores. Scores are weighted and range from 0 (dependence) to 100 (independence).

Interpretability: Scores reflect the nursing burden and social acceptability of the activity. Cut scores have been established on the stroke population and are not necessarily representative for the SCI population. Scores of 0-20 indicate total dependence; 21-60: severe dependence; 61-90: moderate dependence and 91-99: slight dependence. 

Acceptability: Though the test items are deemed important to society, they may not reflect activities that are of importance to individuals with SCI.

Languages: The 10 item English version has been assessed for the SCI population.

Usability: There is minimum patient burden unless the entire test is scored by observation. Only the modified BI has published properties for the SCI population. Floor and ceiling effects makes the scale less useful for the SCI population.

Time to administer: 2-10 minutes to complete (more if assessed by observation).

Time to score: N/a

Training required: No training is required though clinical experience/practice is beneficial.

Availability: N/a

Equipment required: None

Summary:

  • The BI is one of the best researched ADL tools and has been used with a number of patient populations. Use of adaptive aids is permitted with a score of ‘independent’.
  • The BI covers very basic functional abilities and while a score of 100 suggests independence, assistance may still be required with other higher order tasks such as cooking/cleaning and therefore other measures are needed to assess these areas.

Psychometric Summary

Reliability

Validity

Responsiveness

Results

Results

Results

Floor/ceiling

IC/TR: Green light

Inter O: Yellow light

Criterion: Green light

Construct: Yellow light

Green light

Floor/Ceiling: Yellow light

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

  • Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil 1979;60:145-154.
  • Kucukdeveci AA, Yavuzer G, Tennant A, Suldur N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med 2000;32:87-92.
  • Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J 1965;14:61-65.