Barthel Index

David Goldemund M.D.
Updated on 05/11/2023, published on 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, bladder and bowel control, moving from wheelchair to bed and returning, walking on a level surface (or propelling a wheelchair if unable to walk), and ascending and descending stairs
time required for administration
- self-report: approx. 2-5 minutes
- direct observation: approx. 20 minutes
the Barthel Index should not be used alone to predict the outcome

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 (several definitions of categories can be found in the literature)