ADD-ONS / SCALES

Barthel Index

Created 02/09/2022, last revision 02/09/2022


  • validated questionnaire scoring activities of daily living (ADL)
  • originally used for patients with neuromuscular and musculoskeletal disorders, but its use has been extended to patients with various disabilities
  • the Barthel Index assesses functional limitations in 3 grades (0-5-10 points) in a total of 10 domains (i.e., 0-100 points in total)
    • feeding, personal toileting, bathing, dressing, and undressing, getting on and off a toilet, controlling the bladder, controlling bowel, moving from wheelchair to bed and returning, walking on level surface (or propelling a wheelchair if unable to walk), and ascending and descending stairs
  • time to administer
    • self-report: approx. 2-5 minutes
    • direct observation:  approx. 20 minutes
  • the Barthel Index should not be used alone for predicting outcomes

How to score

  • the aim is to determine the degree of independence from any assistance (physical or verbal)
  • assess what the patient actually does, not what he/she wants or is supposed to do
  • source of information for scoring:
    • asking the patient, friends, relatives, medical staff
    • by direct observation (not necessary)
  • a full score (independence) excludes even minimal help or the presence (supervision) of another person
  • middle categories imply that the patient supplies over 50% of the effort
  • the patient can use mechanical aids (handrails on walls, sticks, crutches, etc.) to be independent
  • ad point 9 – movement in a wheelchair independently controlled by the patient is scored by 15
Activity
 
Points
1. Feeding
INDEPENDENT
(food provided within reach)
10
NEEDS HELP
(cutting, spreading butter, etc. )
5
UNABLE
0
2. Dressing
INDEPENDENT
(including buttons, zips, laces, etc.)
10
NEEDS HELP
(can do about half unaided )
5
UNABLE
0
3. Bathing
INDEPENDENT
5
UNABLE
0
4. Grooming
INDEPENDENT
face/hair/teeth/shaving (implements provided)
5
NEEDS HELP
0
5. Bowel control
CONTINENT
10
OCCASIONAL ACCIDENT
5
INCONTINENT
(or needs to be given enemas)
0
6. Bladder control
CONTINENT
(catheterized and able to manage alone)
10
OCCASIONAL ACCIDENT
(once per day)
5
INCONTINENT
(or catheterized, unable to manage alone)
0
7. Toilet use
(including transfer, on and off, dressing, wiping)
INDEPENDENT
10
NEEDS SOME HELP
5
UNABLE
0
8. Transfers (bed to chair and back)
INDEPENDENT
15
NEEDS MINOR HELP
(verbal or physical)
10
NEEDS MAJOR HELP (1-2 people, physical), can sit
5
UNABLE
(no sitting balance)
0
9. Mobility on level surfaces
INDEPENDENT (but may use any aid, e.g., stick) >50 m
15
Walks with the help of one person (verbal or physical) >50m
10
Wheelchair, independent, including corners, >50m
5
IMMOBILE OR or <50m
0
10. Stairs
INDEPENDENT
(up and down)
10
NEEDS HELP (verbal, physical, carrying aid)
5
UNABLE
0

According to the total score, patients are sorted into several categories (multiple definitions of categories can be found in the literature)

Score interpretation
0-20 total dependence
21-60
severe dependence
61-90
moderate dependence
91-99
slight dependence
100
independence
Score interpretation
0-40 highly dependent
45-60
partially dependent
65-95
minimally dependent
95-100
independent
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