The Barthel scale is an
ordinal scale
Ordinal data is a categorical, statistical data type where the variables have natural, ordered categories and the distances between the categories are not known. These data exist on an ordinal scale, one of four levels of measurement described b ...
used to measure performance in
activities of daily living
Activity may refer to:
* Action (philosophy), in general
* Human activity: human behavior, in sociology behavior may refer to all basic human actions, economics may study human economic activities and along with cybernetics and psychology may s ...
(ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking.
It uses ten variables describing ADL and mobility. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital. The amount of time and physical assistance required to perform each item are used in determining the assigned value of each item. External factors within the environment affect the score of each item. If adaptations outside the standard home environment are met during
assessment, the participant's score will be lower if these conditions are not available. If adaptations to the environment are made, they should be described in detail and attached to the Barthel index.
The scale was introduced in 1965,
and yielded a score of 0–100 (Mahoney, F.I. & Barthel, D.W., 1965. Functional Evaluation: The Barthel Index. Maryland state medical journal, 14, pp. 61–65.). Collin et al. (1988) argued that the original scoring system gave an exaggerated impression of accuracy and subsequently proposed a modification where each domain was scored in one-point increments with a full score of 20 indicating functional independence (Collin, C. et al., 1988. The Barthel ADL Index: a reliability study. International disability studies, 10(2), pp. 61–63.). The sensitized version sharply discriminates between good and better and poor and poorer performances. Its effectiveness is not just with in-patient rehabilitation but home care, nursing care, skilled nursing, and community. The Barthel index signifies one of the first contributions to the functional status literature and it represents
occupational therapist
Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abi ...
s' lengthy period of inclusion of functional mobility and ADL measurement within their scope of practice.
The scale is regarded as reliable, although its use in
clinical trial
Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
s in
stroke medicine is inconsistent. It has however, been used extensively to monitor functional changes in individuals receiving in-patient rehabilitation, mainly in predicting the functional outcomes related to stroke. The Barthel index has been shown to have portability and has been used in 16 major diagnostic conditions as well as different clinical settings (e.g., nursing homes) with satisfactory reliability and validity.
The Barthel index has demonstrated high
inter-rater reliability
In statistics, inter-rater reliability (also called by various similar names, such as inter-rater agreement, inter-rater concordance, inter-observer reliability, inter-coder reliability, and so on) is the degree of agreement among independent obse ...
(0.95) and
test–retest reliability
Repeatability or test–retest reliability is the closeness of the agreement between the results of successive measurements of the same measure, when carried out under the same conditions of measurement. In other words, the measurements are taken ...
(0.89) as well as high correlations (0.74–0.8) with other measures of physical disability.
Copyright Information: The Maryland State Medical Society holds the copyright for the Barthel Index. It may be used freely for noncommercial
purposes with the following citation: Mahoney FI, Barthel D. "Functional evaluation: the Barthel Index." Maryland State Med Journal 1965;14:56-61. Used with permission. Permission is required to modify the Barthel Index or to use it for commercial purposes.
Variables
The ten variables addressed in the Barthel scale are:
[
* Presence or absence of ]fecal incontinence
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referre ...
* Presence or absence of urinary incontinence
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geri ...
* Help needed with grooming
* Help needed with toilet use
* Help needed with feeding
* Help needed with transfers (e.g. from chair to bed)
* Help needed with walking
* Help needed with dressing
* Help needed with climbing stairs
* Help needed with bathing
See also
* Modified Rankin Scale
References
External links
1965 (original version) online calculator at pmidcalc.org
Stroke Center reprint
{{Webarchive, url=https://web.archive.org/web/20150226072457/http://www.strokecenter.org/wp-content/uploads/2011/08/barthel.pdf , date=2015-02-26
Free online Barthel Index calculator
Rehabilitation medicine
Medical scales
Occupational therapy