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Barthel Index

Learning objectives

  • Uses of Barthel Index in rehabilitation
  • How to do this reliably


Choose the scoring point for the statement that most closely corresponds to the patient's current level of ability for each of the following 10 items. Record actual, not potential, functioning. Information can be obtained from the patient's self-report, from a separate party who is familiar with the patient's abilities (such as a relative), or from observation. Refer to the Guidelines section on the following page for detailed information on scoring and interpretation.

The Barthel Index

BowelsIncontinent (or needs to be given enema) Occasional accident (once/week) Continent
BladderIncontinent, or catheterized and unable to manage Occasional accident (max. once per 24 hours) Continent (for over 7 days)
GroomingNeeds help with personal care Independent face/hair/teeth/shaving (implements provided)
Toilet useDependent Needs some help, but can do something alone Independent (on and off, dressing, wiping)
FeedingUnable Needs help cutting, spreading butter, etc. Independent (food provided within reach)
TransferUnable – no sitting balance Major help (one or two people, physical), can sit Minor help (verbal or physical) Independent
MobilityImmobile Wheelchair independent, including corners, etc. Walks with help of one person (verbal or physical) Independent (but may use any aid, e.g., stick)
DressingDependent Needs help, but can do about half unaided Independent (including buttons, zips, laces, etc.)
StairsUnable Needs help (verbal, physical, carrying aid) Independent up and down
BathingDependent Independent (or in shower)
Total Score: Sum the patient's scores for each item. Total possible scores range from 0 – 20, with lower scores indicating increased disability. If used to measure improvement after rehabilitation, changes of more than two points in the total score reflects a probable genuine change, and change on one item from fully dependent to independent is also likely to be reliable.

The Barthel ADL Index: Guidelines

  • The index should be used as a record of what a patient does, not as a record of what a patient could do.
  • The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason.
  • The need for supervision renders the patient not independent.
  • A patient's performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources
  • Direct observation and common sense are also important. However direct testing is not needed.
  • Usually the patient's performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant.
  • Middle categories imply that the patient supplies over 50 per cent of the effort.
  • Use of aids to be independent is allowed

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