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The Barthel Index or Barthel scale or Barthel ADL index is an ordinal scale used to measure performance in activities of daily living (ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking.[1] It uses ten variables describing ADL and mobility. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital. The amount of time and physical assistance required to perform each item are used in determining the assigned value of each item. External factors within the environment affect the score of each item. If adaptations outside the standard home environment are met during assessment, the participant’s score will be lower if these conditions are not available. If adaptations to the environment are made, they should be described in detail and attached to the Barthel index. [2]

The scale was introduced in 1965,[3] and yielded a score of 0–20. Although this original version is still widely used, it was modified by Granger et al. in 1979, when it came to include 0–10 points for every variable,[4] and further refinements were introduced in 1989.[5]. The modified Barthel index was designed as the original scale was insensitive to change and had arbitrary scores. The sensitized version sharply discriminates between good and better and poor and poorer performances. Its effectiveness is not just with in-patient rehabilitation but home care, nursing care, skilled nursing, and community. The Barthel index signifies one of the first contributions to the functional status literature and it represents occupational therapists' lengthy period of inclusion of functional mobility and ADL measurement within their scope of practice.[1] The scale is regarded as reliable, although its use in clinical trials in stroke medicine is inconsistent.[6] It has however, been used extensively to monitor functional changes in individuals receiving in-patient rehabilitation, mainly in predicting the functional outcomes related to stroke. The Barthel index has been shown to have portability and has been used in 16 major diagnostic conditions. The Barthel index has demonstrated high interrator reliability (0.95) and test re-test reliability (0.89) as well as high correlations (0.74–0.8) with other measures of physical disability.[1]

  • Area 1: Controlling bowels
- is continent (10 points) 
  - has occasional accidents (5 points) 
  - is incontinent (0 point)
  • Area 2: Controlling bladder (the week preceding the test)
- is continent (10 points) 
  - has occasional accidents (5 points) 
  - is incontinent (0 point)
  • Area 3: Personal hygiene
- can wash face and hands, clean teeth, shave, comb hair (5 points) 
  - needs assistance (0 point)
  • Area 4: Getting on and off toilet
- can fasten and unfasten clothes, prevent soiling of clothes and use toilet paper (10 points) 
  - needs some help, but can do something alone (5 points) 
  - is dependent (0 point)
  • Area 5: Feeding
- can feed himself/herself (10 points) 
  - needs some help cutting food etc. (5 points) 
  - is dependent (0 point)
  • Area 6: Mobility
- is able to move from wheelchair to bed and back (15 points) 
  - needs some minor help or needs to be supervised for safety (10 points) 
  - can come to a sitting position without the help but needs to be lifted out of bed (5 points) 
  - is completely dependent (0 point)
  • Area 7: Walking on level surfaces
- can walk without help (other than stick or frame) more than 50 yards  (15 points) 
  - needs help to walk (10 points) 
  - can propel a wheelchair in an independent manner, can sit (5 points) 
  - is immobile or cannot walk more than 50 yards (0 points)
  • Area 8: Dressing
- is able to put on, remove and fasten all clothing (10 points) 
  - needs help dressing(5 points) 
  - is dependent (0 point)
  • Area 9: Ascending and descending stairs
- is able to go up and down  stairs safely without help. (10 points) 
  - needs assistance or supervision (5 points) 
  - is unable to go up or down (0 point)
  • Area 10: Bathing
- can use a bath or shower, or take a sponge bath (5 points) 
  - needs assistance or supervision (0 point)

See also[]

  • Modified Ranking Scale


  1. 1.0 1.1 1.2 O'Sullivan, Susan B; Schmitz, Thomas J (2007). Physical Rehabilitation, Fifth Edition, 385, Philadelphia, PA: F.A. Davis Company.
  2. Carroll, Douglas Functional Evaluation: The Barthel Index. URL accessed on 12 May 2011.
  3. Mahoney F. Barthel D (1965). Functional evaluation: the Barthel Index. Md Med J 14: 61–65.
  4. Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE (January 1979). Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil 60 (1): 14–7.
  5. Shah S, Vanclay F, Cooper B (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 42 (8): 703–9.
  6. Sulter G, Steen C, De Keyser J (August 1999). Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 30 (8): 1538–41.

External links[]

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