Barthel Index

Original Editor - Gayatri Jadav Upadhyay

Top Contributors - Stacy Schiurring, Kim Jackson, Jess Bell, Lucinda hampton, Lauren Lopez, Gayatri Jadav Upadhyay, George Prudden, WikiSysop, Shaimaa Eldib and Areeba Raja  

Objective

The Barthel scale/index (BI) is an ordinal scale used to measure performance in activities of daily living (ADL). Ten variables describing ADL and mobility are scored, a higher number being a reflection of greater ability to function independently following hospital discharge.Time taken and physical assistance required to perform each item are used in determining the assigned value of each item. The Barthel Index measures the degree of assistance required by an individual on 10 items of mobility and self care ADL.

Intended Population

Patients with stroke, patients with other neuromuscular or musculoskeletal disorders, oncology patients

Method of Use

Time to administer- Self report: 2-5 minutes; Direct observation: 20 minutes, Times may vary depending on clients tolerance and abilities. The MBI/BI is simple to administer. Requires training if administered by direct observation. It has been developed in many forms that can be administered in many situations and can be used for longitudinal assessment.

The Barthel index !0 items, see below for scoring.

Bowels
Bladder
Grooming
Toilet use
Feeding
Transfer
Mobility
Dressing
Stairs
Bathing

Bowels - 0 Incontinent (or needs to be given enemata), 1 = occasional accident (once/week), 2 = continent

Bladder-  0 incontinent, or catheterized and unable to manage, 1 = occasional accident (max. once per 24 hours), 2 = continent (for over 7 days)

Grooming- 0 needs help with pers

onal care, 1 = independent face/hair/teeth/shaving (implements provided)

Toilet use- 0 dependent, 1 = needs some help, but can do something alone, 2 = independent (on and off, dressing, wiping)

Feeding-  0- unable, 1 = needs help cutting, spreading butter, etc., 2 = independent (food provided within reach)

Transfer-  0- unable – no sitting balance, 1 = major help (one or two people, physical), can sit, 2 = minor help (verbal or physical), 3 = independent

Mobility- 0 immobile, 1 = wheelchair independent, including corners, etc., 2 = walks with help of one person (verbal or physical), 3 = independent (but may use any aid)

Dressing- 0 dependent, 1 = needs help, but can do about half unaided, 2 = independent (including buttons, zips, laces etc)

Stairs-0 unable, 1 = needs help (verbal, physical, carrying aid), 2 = independent up and down

Bathing-0 dependent, 1 = independent (or in shower)

Important points when administering test

Record of what a patient does, not what a patient could do

Aim to establish degree of independence from any help, physical or verbal

Need of supervision renders the patient not independent

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% of the effort

Aide use is allowed to be independent

The below video gives a great overview of the test.

Versions

Modified 10-item version (MBI); 5-item short form; The expanded 15-item version; The extended BI (EBI); The 3-item BI; Self-rating BI (SB); Early Rehabilitation Barthel Index (ERI)Level of measurements are limited to either complete independence or needing assistance. Each performance item is scored on an ordinal scale with a specified number of points assigned to each level or ranking.

Reliability

The MBI amd BI are reliable tests to administer.

Five studies of the MBI reported excellent internal consistency: one study of the MBI reported excellent test-retest reliability; one study of the MBI and 4 studies of BI reported excellent inter-rater reliability; and 1 study of the BI reported adequate inter-rater reliability

As a predictive tool the the MBI predicted instrumental ADL performance at 6-months post-stroke: likelihood a patient will regain continence following stroke; risk for falls in patients with stroke; functional recovery following stroke; and acute care hospital length following stroke.

Responsiveness

Ability to detect change in patients is poor in highly functional individuals, a ceiling effect being noted.

References

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