The Barthel Index, also known as the Barthel ADL Index, is a standardized assessment tool used by healthcare professionals to measure a person’s level of functional independence. Developed by Florence Mahoney and Dorothea Barthel in 1965, the index provides a quantitative measure of disability by evaluating a patient’s ability to perform activities of daily living (ADLs). It is widely used across rehabilitation, geriatric care, and long-term care settings to establish a baseline of physical function and track changes over time. The core function of the index is to help clinicians determine the amount of physical assistance a person requires to manage their self-care and mobility.
What the Barthel Index Measures
The Barthel Index specifically evaluates ten fundamental tasks of self-care and mobility, which are considered the basic Activities of Daily Living (ADLs). These ten items are categorized into three main areas: mobility, self-care, and continence.
The ten tasks assessed are:
- Feeding (ability to eat independently)
- Grooming (personal hygiene tasks)
- Bathing (capacity to wash oneself)
- Dressing (ability to put on and remove clothing)
- Transfers (moving from a bed to a chair and back)
- Mobility (ability to walk on a level surface or operate a wheelchair independently)
- Stairs (ability to navigate stairs)
- Bowel control (level of continence)
- Bladder control (level of continence)
- Toilet Use (ability to get on and off the toilet, clean oneself, and manage clothing)
By focusing on these specific ten tasks, the Barthel Index offers a clear, objective profile of a person’s physical functional status.
The Mechanics of Barthel Index Scoring
The Barthel Index is scored by assigning points to each of the ten activities based on the level of physical assistance a person requires to complete the task. The total possible score is 100 points, which represents complete functional independence in all ten areas. Scoring for each task is weighted, with a higher value placed on mobility and continence tasks, reflecting their significant impact on independence.
Scores are assigned using increments of 0, 5, 10, or 15 points, depending on the specific task and the degree of independence demonstrated. For example, a task like Feeding or Dressing is typically scored in 5- or 10-point increments. More complex tasks like Transfers and Mobility are assigned a higher maximum point value, often up to 15 points, to allow for finer distinctions in ability. A score of 0 for any item signifies total dependence. The final score is the sum of the points achieved across all ten categories, providing a single number that reflects the patient’s overall functional status.
Interpreting Functional Dependency Levels
The resulting total score from the Barthel Index provides a standardized measure that healthcare providers use to classify a person’s level of functional dependence. A score of 100 indicates that the person is fully independent and requires no physical help for any of the ten activities.
A score in the range of 91 to 99 is interpreted as slight dependence, meaning the individual is independent in most tasks but may require minimal assistance or supervision. Scores between 61 and 90 are categorized as moderate dependence, suggesting the person requires some hands-on help for a moderate number of daily tasks. For instance, a score of 65 often indicates that while a person can manage self-care tasks with minimal help, they require physical assistance for transfers and mobility. A score of 60 is considered a demarcation point, below which a person transitions toward greater dependence.
A total score between 21 and 60 is classified as severe dependence, indicating the person needs substantial help with most of their ADLs. Scores of 20 or below indicate total dependence, meaning the person is unable to perform most tasks without full assistance. Clinicians use these dependency levels to monitor a patient’s progress during rehabilitation and inform discharge planning, as a higher score correlates with a greater likelihood of returning home with independence.