Functioning scale

Barthel Index

Main reference: Wade DT, Collin C: The Barthel ADL Index: a standard measure of physical disability? International Disability Studies 10:64–67, 1988.

Type: Clinician-rated scale. Self report version also available

Main indications: Used to assess independence in 10 activities of daily living.

Rating performed by: Trained health professionals or self report.

Time period covered by scale: The present.

Time required to complete rating: 5 minutes. Structured interview.

Remarks: The Barthel ADL Index assesses independence in 10 areas of functioning:

• Feeding
• Bathing
• Grooming
• Dressing
• Continence of bowels
• Continence of bladder
• Toilet use
• Transfers
• Mobility 

Each area is scored separately. The worst possible total score is 0, the best is either 20 or 100, depending on whether 1-point increments or 5-point increments are used.

The BI aims to quantify the degree of independence of the patient; the use of aids to be independent is allowed, but a need for supervision, whether or not aids are needed, renders the patient not fully independent.

The patient's performance can be established using the best available evidence: this might include questions to the patient, friends or carers, direct observation of the patient, and common-sense inferences. Direct testing is not necessarily required.

Copious psychometric evaluations indicate the BI is a robust measure for people with moderate and severe disability. Prominent ceiling effects in people with mild levels of disability.

See also Medical Outcomes Study 36-item Short-Form Health Survey (SF-36).