Barthel Index for ADLs

Overview

Author(s): Mahoney, F.I. & Barthel, D.W.

Year of Publication: 1965 (expanded 1976 & 1988)

Publisher: Maryland State Medical Journal

Type of Assessment: Performance Measure/Interview

• Observation-based 

Cost: Free

How to Access: https://www.sralab.org/sites/default/files/2017-07/barthel.pdf 

Age: Older Adults

Diagnoses: Neuromuscular or musculoskeletal conditions (stroke, Parkinson's, spinal cord injuries, MS, mobility limitations)

Setting: Inpatient rehab, home health, acute care, outpatient rehab, skilled nursing facilities/assisted living

Areas Assessed:

ADLs, Functional Mobility, Gait

• Feeding

• Bathing

• Grooming

• Dressing

• Bowel control

• Bladder control

• Toileting

• Chair transfer

• Ambulation

• Stair climbing

Administration

Time: <20 mins 

• Self-report=2-5 mins

• Direct Observation = 20-25 mins

Group/Individual: Individual

Subtests: 10

Instructions: Therapist will rate items based on the amount of assistance required or how independently the client can complete 10 daily activities 

• The therapist will observe the client perform, inquire about their abilities without watching them do it, or speak with a care partner or caregiver who is familiar with their capabilities to perform tasks

• Use of adaptive equipment and aids like wheelchairs and walkers are permitted

Materials: Form, pencil

User Qualifications: N/A

Scoring Procedures

How to Score: Scores should be rated on a scale of 0-10 points for each category to be summed for a maximum total of 100 points

• 0 points = inability

• 5 points = assistance (except for Bathing & Grooming sections = independent)

• 10 points = independent performance (except for transfers/mobility = minor help {verbal/physical})

• *15 points = independent performance (only for Transfers & Mobility section)

  • E.g.: Feeding: 0=unable; 5=needs help cutting, spreading butter, etc., or required modified diet; 10=independent

  • E.g.: Transfers: 0 = unable, no sitting balance; 5= major help (1-2 people, physical), can sit; 10 = minor help (verbal or physical); 15 = independent

• Scores for each category will be written on the line corresponding to the category

• *Scores should be indicative of what the client does, not a record of what they could do.

Score Indications:

• Higher scores (100) are indicative of higher independence in functioning

• Lower scores (0) indicate dependence and need for additional assistance/care

Psychometrics

Reliability: Mixed

• Interrater Reliability: Mixed

  • Excellent: r=0.849 (p<0.001)

  • Adequate: ICC = 0.74-0.96 (depending on item)

  • Moderate: Cohen’s K = 0.64-0.85 (depending on item)

• Internal Consistency: Excellent

  • Alpha = 0.94

  • Cronbach’s alpha = 0.94

Validity: Mixed

• Predictive Validity - Moderate

  • Rho=-0.42

• Construct Validity - Excellent

  • Excellent: r = 0.84

Pros & Cons

Strengths:

• Quick, simple, easy to use that focuses specifically on basic ADLs

• Objective measurement that allows for progress tracking over time

• Widely applicable to various populations and diagnostic conditions

• Good reliability & sensitivity to changes in ADL ability

• Allows for use of adaptive equipment to reflect day-to-day functioning and performance in a true environment

• Modified versions include foreign language translations (Chinese, Danish, French, German, Italian, & Korean), different item amounts, and improved sensitivity to changes 

Weaknesses:

• Limited scope on basic ADLs but does not account for IADLs or internal/environmental factors impacting functioning/performance

• Insensitive to small changes in functional status (ceiling effect)

• The allowance of adaptive equipment may not accurately reflect true functional ability without it

• The lack of consensus on cutoff scores (eg. 10 in Dressing is different from a 10 in Transfers) can cause confusion and increase risk of error 

References

• Asher, I. E. (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.). AOTA Press.

• Shirley Ryan Ability Lab. (2020, May 21). Barthel index. https://www.sralab.org/rehabilitation-measures/barthel-index  

• Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Bathel index. Maryland State Medical Journal, 14, 56-61. https://www.sralab.org/sites/default/files/2017-07/barthel.pdf 

• Stavrou, A. (2023). Using the Barthel index or Modified Barthel index in occupational therapy. My OT Spot. https://www.myotspot.com/barthel-index/