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Assessment Tools: Barthel Index

 

Title Barthel Index

Authors Mahoney, F., Barthel, D.W.

Summary The Barthel Index was developed to measure functional independence in personal care and mobility. It monitors performance in chronic patients before and after treatment and to indicate the amount of nursing care needed (Mahoney, 1958). It has been used with rehabilitation patients to predict length of stay, estimate prognosis, anticipate discharge outcomes, and as an evaluative instrument. (McDowell, 1998).

Format 10-item perfomance-based instrument consisting of two to four-point response scales that evaluates activities of daily living (Mahoney, 1965). Modified versions include a 10-item scale that re-ordered the orginal ten items, clarified the rating instructions and modified the scores for each item totalling 20 (Collin, 1988). Another instrument commonly called the Modified Barthel Index covers 15 items and uses four-point response scales for most items (Granger, 1981). Another adaptation proposed a five point response scale for each item to improve sensitivity in detecting change (Shah, 1989).

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Population Individuals with disabilities affecting activities of daily living.

Scoring

Scores range between 0 and 100, wth a score of 100 corresponding to the highest level of independence. Each item is assigned a score of 0, 5 10, or 15 based on what the patient cannot do; each item is weighted differently and reflects the importance of each type of disability in terms of assistance required (Mahoney, 1965). The items covered are:

  • Feeding
  • Moving from wheelchair to bed and return
  • Personal toilet (wash face, comb hair, shave, clean teeth)
  • Getting on and off toilet (handling clothes, wipe, flush)
  • Bathing self
  • Walking of level surface (or if unable to walk, propel wheelchair)
  • Ascend and descend stairs
  • Dressing (includes tying shoes, fastening fasteneres)
  • Controlling bowels
  • Controlling bladder

One modified version include a 10-item scale covering the same items above with a three-point scale of 0, 1, or 2 based on what the patient can do, for a total score of 20 (Collin, 1988).

The 15-item Modified Barthel Index has overall scores ranging from 0 - 100 (Granger, 1981). The items covered are:

  • Drink from cup/feed from dish
  • Dress upper body
  • Dress lower body
  • Don brace or prosthesis
  • Grooming
  • Wash or bathe
  • Bladder continence
  • Bowel continence
  • Care of perineum/clothing at toilet
  • Transfer, chair
  • Transfer, toilet
  • Transfer, tub or shower
  • Walk on level 50 yards or more
  • Up and down stairs for one flight or more
  • Wheelchair/50 yards - only if not walking

Completion time 20 minutes if perfomance is observed or 5 minutes if information is obtained verbally from client.

Equipment

None


Training None

Key References

Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The barthel ADL index: A reliability study. International Disability Studies, 10(2), 61-63. [PubMed]

Finch, E., & Canadian Physiotherapy Association. (2002). Physical rehabilitation outcome measures : A guide to enhanced clinical decision making (2nd ed.). Hamilton, Ontario: BC Decker. [find in library]

Fortinsky, R. H., Granger, C. V., & Seltzer, G. B. (1981). The use of functional assessment in understanding home care needs. Medical Care, 19(5), 489-497. [PubMed]

Granger, C. V., Albrecht, G. L., & Hamilton, B. B. (1979). Outcome of comprehensive medical rehabilitation: Measurement by PULSES profile and the barthel index. Archives of Physical Medicine and Rehabilitation, 60(4), 145-154. [PubMed]

Granger, C. V., Dewis, L. S., Peters, N. C., Sherwood, C. C., & Barrett, J. E. (1979). Stroke rehabilitation: Analysis of repeated barthel index measures. Archives of Physical Medicine and Rehabilitation, 60(1), 14-17. [PubMed]

Granger, C. V., Sherwood, C. C., & Greer, D. S. (1977). Functional status measures in a comprehensive stroke care program. Archives of Physical Medicine and Rehabilitation, 58(12), 555-561. [PubMed]

Granger, C. V., Greer, D. S., Liset, E., Coulombe, J., & O'Brien, E. (1975). Measurement of outcomes of care for stroke patients. Stroke; a Journal of Cerebral Circulation, 6(1), 34-41. [PubMed]

Gresham, G. E., Phillips, T. F., & Labi, M. L. (1980). ADL status in stroke: Relative merits of three standard indexes. Arch Phys Med Rehabil, 61, 355-358. [PubMed]

Loewen, S. C., & Anderson, B. A. (1990). Predictors of stroke outcome using objective measurement scales. Stroke, 21, 78-81. [PubMed]

Mahoney, F. I., Wood, O. H., & Barthel, D. W. (1958). Rehabilitation of chronically ill patients: The influence of complications on the final goal. South Med J, 51, 605-609. [PubMed]

McDowell, I., & Newell, C. (1996). Measuring health : A guide to rating scales and questionnaires (2nd ed.). New York: Oxford University Press. [find in library]

Roy, C. W., Togneri, J., Hay, E., & Pentland, B. (1988). An inter-rater reliability study of the barthel index. Int J Rehabil Res, 11, 67-70.

Shinar, D., Gross, C. R., Bronstein, K. S., Licata-Gehr, E. E., Eden, D. T., & Cabrera, A. R. et al. (1987). Reliability of the activities of daily living scale and its use in telephone interview. Archives of Physical Medicine and Rehabilitation, 68(10), 723-728. [PubMed]

Wade, D. T., & Hewer, R. L. (1987). Functional abilities after stroke: Measurement, natural history and prognosis. Journal of Neurology, Neurosurgery, and Psychiatry, 50(2), 177-182. [PubMed]

Wylie, C. M. (1967). Measuring end results of rehabilitation of patients with stroke. Public Health Reports (Washington, D.C. : 1974), 82(10), 893-898. [PubMed]


Sources

Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The barthel index. Maryland State Medical Journal, 14, 61-65. (original) [PubMed]

Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The barthel ADL index: A reliability study. International Disability Studies, 10(2), 61-63. (10 item modified) [PubMed]

Fortinsky, R. H., Granger, C. V., & Seltzer, G. B. (1981). The use of functional assessment in understanding home care needs. Medical Care, 19(5), 489-497. (15 item modified) [PubMed]

Barthel Index. Retrieved July 21, 2005, from Washington University, International Stroke Center Web site: http://www.neuro.mcg.edu/mcgstrok/indices/barthel_Ind.htm

Barthel Index. Retreived July 21, 2005, from the Internet Stroke Center Web site: http://www.strokecenter.org/trials/scales/barthel.pdf

Barthel ADL Index (scale and calculator). Retrieved July 21, 2005, from Yale University, Department of Neurology Web site: http://info.med.yale.edu/neurol/residency/barthel.html


Cost Nil

 




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