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).
|0=dependent; 5=needs help; 10=independent|
|0=dependent; 5=occasional accident; 10=independent|
|0=unable, 5=major help needed; 10= minor help; 15=independent|
|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
Acceptability: Though the test items are deemed important to society, they may not reflect activities that are of importance to individuals with
Languages: The 10 item English version has been assessed for the
Usability: There is minimum patient burden unless the entire test is scored by observation. Only the modified BI has published properties for the
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.
Equipment required: None
- 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.
IC/TR: Green light
Inter O: Yellow light
Criterion: Green light
Construct: Yellow 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.
- 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.