Barthel Index

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. [1]

Intended Population

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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 includes 10 personal activities: feeding, personal toileting, bathing, dressing and undressing, getting on and off a toilet, controlling bladder, controlling bowel, moving from wheelchair to bed and returning, walking on level surface (or propelling a wheelchair if unable to walk) and ascending and descending stairs.

The original Index is a three-item ordinal rating scale completed by a therapist or other observer in 2-5 minutes. Each item is rated in terms of whether the patient can perform the task independently, with some assistance, or is dependent on help based on observation (0=unable, 1=needs help, 2=independent). The final score is x 5 to get a number on a 100 point score. Proposed guidelines for interpreting Barthel scores are that scores of 0-20 indicate “total” dependency, 21-60 indicate “severe” dependency, 61-90 indicate “moderate” dependency, and 91-99 indicates “slight” dependency.2 Most studies apply the 60/61 cutting point. Note- the Barthel Index should not be used alone for predicting outcomes.[2]

The Barthel Index Items and Scoring

The following is referenced from Scribd[3].

Bowels

0 = Incontinent (or needs to be given enema)

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 personal 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

The Royal Australasian College of General Physicians[4] recommends keeping the following in mind when administering the Barthel Index.

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.

[5]

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[6].

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.[6]

Responsiveness

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

Resources

Heart and Stroke Foundation; Canadian Partnership for Stroke Recovery. Stroke Engine. Barthel Index. This website has an excellent summary of the Barthel Index, its use and its psychometric properties.

References

  1. Wikipedia. Barthel Scale. Available from: https://en.wikipedia.org/wiki/Barthel_scale (last accessed 27.4.2019)
  2. Elite learning. The original Barthel index of ADLs. Available from: https://www.elitecme.com/resource-center/rehabilitation-therapy/the-original-barthel-index-of-adls/ (last accessed 30.4.2019)
  3. Scribd. Barthel index. Available from: https://www.scribd.com/document/101609741/Barthel-Index-0-20 (last accessed 27.4.2019)
  4. RACGP. Barthel Index. Available from: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/tools/barthel-index (last accessed 27.4.2019)
  5. John Adamson. How to Interpret - The Barthel Index. Available from: https://www.youtube.com/watch?v=0TyPiuvgfho&feature=youtu.be (last accessed 27.4.2019)
  6. 6.0 6.1 Heart and Stroke Foundation; Canadian Partnership for Stroke Recovery. Stroke Engine. Barthel Index. Accessed 24 June 2019.