Barthel 

Basic Information

• Title/Author(s):
  Barthel Index of Activities of Daily Living
  Developed by: Dorothea Barthel and Florence Mahoney
  
  

• Edition and Year:
  Originally published in 1965.
  Continuously adapted and validated across healthcare systems including the Shirley Ryan AbilityLab and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
  
  

Assessment Details

• Identify TWO Types:
  
  

  • Occupation-based assessment
    
    

  • Observation-based and/or interview-based assessment
    
    

• Cost & Accessibility:
  
  

  • Cost:
    
    

    • Free for clinical and research use.
      
      

  • Access:
    
    

    • Available through Shirley Ryan AbilityLab
      
      

    • Publicly available PDFs through clinical and academic organizations.
      
      

Population & Setting

• Population:
  
  

  • Primarily designed for adults and older adults with:
    
    

    • Neurological conditions (e.g., stroke, multiple sclerosis, Parkinson’s disease)
      
      

    • Orthopedic impairments (e.g., hip fractures, deconditioning)
      
      

    • Chronic health conditions (e.g., heart failure, post-COVID syndrome)
      
      

    • Geriatric conditions (e.g., dementia, frailty)
      
      

    • Mental health conditions (e.g., severe depression, schizophrenia affecting ADLs)
      
      

• Settings:
  
  

  • Acute care hospitals
    
    

  • Inpatient and subacute rehabilitation units
    
    

  • Skilled nursing facilities (SNFs)
    
    

  • Home health care
    
    

  • Outpatient therapy
    
    

  • Community-based rehabilitation programs
    
    

Purpose & Areas Assessed

• Purpose:
  
  

  • To measure a person's level of independence in performing 10 basic activities of daily living (ADLs).
    
    

  • Supports discharge planning, determines care needs, tracks functional recovery over time, and assists in goal setting.
    
    

• Areas Assessed (10 Core ADLs):
  
  

  • Feeding
    
    

  • Bathing
    
    

  • Grooming
    
    

  • Dressing
    
    

  • Bowel control
    
    

  • Bladder control
    
    

  • Toileting
    
    

  • Chair/bed transfers
    
    

  • Mobility (walking or wheelchair use)
    
    

  • Using stairs
    
    

Administration & Scoring

• Administration:
  
  

  • Time Required: Approximately 20 minutes.
    
    

  • Format:
    
    

    • Preferred method: Direct observation of the client completing each ADL task whenever possible.
      
      

    • Alternate method: Interview with the client or caregiver when observation is not feasible (e.g., acute medical conditions, telehealth).
      
      

    • Use of assistive devices (e.g., walker, wheelchair) is permitted during assessment.
      
      

• User Qualifications:
  
  

  • Can be administered by occupational therapists, physical therapists, nurses, physicians, or trained rehabilitation professionals.
    
    

• Materials Required:
  
  

  • Barthel Index scoring form
    
    

  • Basic ADL equipment as needed (e.g., grooming supplies, stairs access, bed/chair)
    
    

• Scoring Procedure:
  
  

  • Each ADL item scored at varying scales (0, 5, 10, or 15 points) based on the client's level of assistance needed.
    
    

  • Maximum total score: 100 (indicating complete independence).
    
    

  • Interpretation:
    
    

    • 0–20: Total dependence
      
      

    • 21–60: Severe dependence
      
      

    • 61–90: Moderate dependence
      
      

    • 91–99: Slight dependence
      
      

    • 100: Independent
      
      

Psychometrics/Standardization

• Reliability:
  
  

  • Demonstrates strong test-retest reliability and high interrater reliability, particularly in stroke and neurorehabilitation populations.
    
    

• Validity:
  
  

  • Well-established construct validity for assessing functional independence during rehabilitation.
    
    

• Norms:
  
  

  • Widely used internationally with normative data available for stroke, orthopedic, geriatric, and mixed rehabilitation populations.
    
    

Critical Thinking Sections

Strengths

• Widely validated — Supported by strong psychometric research across multiple populations.
  
  

• Quick and efficient — Can be completed in ~20 minutes.
  
  

• Flexible administration — Allows for both direct observation (preferred) and interview methods when necessary.
  
  

• Tracks functional change — Sensitive enough for monitoring progress over the course of rehabilitation.
  
  

• Freely accessible — No cost to clinicians or researchers.
  
  

• Occupation-focused — Emphasizes functional performance in essential daily life activities.
  
  

Weaknesses

• Less sensitive for mild impairments — May not detect subtle changes in higher-level functioning, particularly as clients near independence.
  
  

• Interview format risks subjectivity — Responses may vary depending on client or caregiver reliability if direct observation isn’t possible.
  
  

• Ceiling effect — May not differentiate among high-functioning clients near the top score range.
  
  

• Focused specifically on basic ADLs — Intentional for the tool's purpose, but does not assess Instrumental ADLs (e.g., shopping, cooking); if IADL performance is a concern, a different tool would be more appropriate.
  
  

References 

Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14(2), 61–65.

Shirley Ryan AbilityLab. (2020, May 21). Barthel Index. Rehabilitation Measures Database. https://www.sralab.org/rehabilitation-measures/barthel-index

National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). (n.d.). Barthel Index Infographic [PDF]. https://www.sralab.org/rehabilitation-measures/barthel-index