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Barthel Index for Activities of Daily Living (ADL)

Calculators  Multiple body systems
The Barthel Index is used to assess mobility and independence in daily living activities.
Feeding
Independent 10
Require help 5
Incapable 0
Bathing
Independent 5
Incapable 0
Grooming
Independent 5
Incapable 0
Dressing
Independent 10
Require help 5
Incapable 0
Bowel Control
Continent 10
Occasionally Accident 5
Incontinent 0
Bladder Control
Continent 10
Occasionally Accident 5
Incontinent (catheterized, Incapable to manage single) 0
Toilet Use
Independent 10
Requires help 5
Incapable 0
Transfers (bed to chair and back)
Independent 15
Requires slight help (verbal or physical) 10
Requires major help (1-2 people, physical), can sit 5
Incapable 0
Flexibility on Horizontal Surfaces
Independent but may use any aid >50 yards 15
Walking with help of a person (verbal or physical) >50 yards 10
Independent of Wheelchair, including corners, >50 yards 5
Immobile or <50 yards 0
Stairs
Independent 10
Require help (physical, verbal, carrying aid) 5
Incapable 0
Result:

Background

Measured Factor
mobility and independence in daily living activities
Measured Factor Detail
Patients who undergo rehabilitation require a method of assessing progess, and this test provides a score for patients based on their ability to perform daily tasks and whether help is required to complete the tasks. A higher score corresponds to increased mobility and independence. The test is useful to help healthcare providers determine when a patient is ready to go home, and how much care will be needed in the home. The test has also been used extensively to predict functional outcomes related to stroke.
Speciality
Rehabilitation Specialist
Body System
Multiple body systems
Measured Factor Low Impact
  • decreased ability to perform daily tasks

Result Interpretation

Ranges Ranges
  • Critical Low: < 20
  • Normal: 80–100
  • Normal Adult Male: 80–100
  • Normal Adult Female: 80–100
  • Normal Geriatric Male: 80–100
  • Normal Geriatric Female: 80–100
Result Low Conditions
  • decreased mobility
  • inability to be independent

Studies

Study Validation 1
This study analyzed the use of the Barthel index in patients in rehabilitation. The test was performed periodically to assess the patients' progress. The study showed that an initial score of 40 or greater corresponded to a higher likliehood of discharge from the rehabilitation facility, and an initial score of 60 or higher corresponded to a shorter duration of stay. The researchers discovered that a score of 40 or less correlated to complete dependence in mobility skills, and a score of 60 was the turning point between dependence and assisted independence.
References: 2
Study Validation 2
This study compared the use of the Barthel index to another test, the PULSES profile. The study determined that both tests are effective in analyzing patient mobility, and either test may be used among rehabilitation centers to assess  functional abilities and progress among patients. The study included 307 severely disabled persons from 10 different rehabilitation sites, and patients were assessed over a period of 2 years.
References: 3
Study Validation 3
This study compared analysis of the Barthel index to the Modified Rankin Scale. The study combined results from 15 different trials and analyzed the data for each test. The tests were then compared to each other. The study found that the tests were very different when indicating favorable outcomes, and it was very difficult to compare the tests to each other. The researchers recommended that it may be beneficial to indicate a negative outcome instead for easier comparison of the tests.
References: 4
Study Additional 1
This study examined the use of the Barthel index among patients aged 75 years and older. This study used self-reporting and observation to assess patients. The two methods of assessment were compared and a discrepancy of 2 points on the mean score was established. Twenty of the 126 patients (15.9%) had a discrepancy of 15 or more points from the self-report to the observation score. Main contirbuting factors to the discrepancy included age, cognitive impairment, and source of patients from the acute geriatric ward. The researchers determined that the Barthel index has limitations among the geriatric population, and the Barthel index does not work well for self-report in this population.
References: 5
Study Additional 2
This study assessed patients' nutritional status compared to their functional status. Three hundred and forty-four elderly patients hospitalized in the General Rehabilitation Center were evaluated using the Barthel index for functional status and the Mini Nutritional Assessment Short Form for nutritional status. Patients were categorized into three age groups: 65-74 yrs, 75-84 yrs, and >85 yrs. The study found that there was a positive correlation between nutritional status and functional status.  Increased functional status was defined as a score of 45 or greater, and this corresponded to an increased nutritional status among the patients. Age distribution and the scores measured with the Barthel Index and Mini Nutritional Assessment Short Form were significantly associated.
References: 6
Study Additional 3
A multicenter, retrospective cohort study analyzed the correlation of the Barthel index to pneumonia requiring hospitalization in 299 residents from long-term care facilities. The researchers found that patients who had hospitalization-requiring pneumonia (HRP) had a much lower Batherl index score compared to patients who did not have HRP (8.6 versus 25.8 points, p<0.001).  And patients with HRP were more likely to have chronic obstructive pulmonary disease than patients without HRP (13.2% versus 3.9%, p = 0.004). Lower Barthel index (odds ratio 0.967; p < 0.001), existence of chronic obstructive pulmonary disease (odds ratio 4.192; p = 0.015), and feeding route (percutaneous endoscopic gastrostomy comparing with oral feeding; odds ratio 0.177; p = 0.012) were independently associated with HRP.  The study determined that the Barthel index is useful among patients at long-term care facilities and may be an accurate indicator for increased risk of HRP.
References: 7

Authors

Dorothea Barthel was the head of the Physical Therapy Department at three Maryland state hospitals, Montebello, Salisbury, and Hagerstown. She developed the "Barthel Index" which has been used by physical therapists to assess the capabilities of stroke patients
https://www.findagrave.com/memorial/79560583/dorothea-beauchamp

References

  1. Mahoney FI, Barthel D. Functional evaluation: The Barthel Index. Md State Med J. 1965 Feb;14:61-5
  2. Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE. Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil. 1979 Jan;60(1):14-7.
  3. Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil. 1979 Apr;60(4):145-54.
  4. Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999 Aug;30(8):1538-41.
  5. Sinoff G, Ore L.The Barthel activities of daily living index: self-reporting versus actual performance in the old-old (> or = 75 years). J Am Geriatr Soc. 1997 Jul;45(7):832-6.
  6. Villafañe JH, Pirali C, Dughi S, Testa A, Manno S, Bishop MD. Association between malnutrition and Barthel Index in a cohort of hospitalized older adults article information. J Phys Ther Sci. 2016 Jan;28(2):607-12.
  7. Shiao CC, Hsu HC, Chen IL, Weng CY, Chuang JC, Lin SC, et al. Lower Barthel Index Is Associated with Higher Risk of Hospitalization-Requiring Pneumonia in Long-Term Care Facilities. Tohoku J Exp Med. 2015 Aug;236(4):281-8.