Barthel Index

The Barthel Index is an important assessment tool in occupational therapy that measures an individual's ability to perform activities of daily living skills (ADLs). Developed by Dr. Dorethea Barthel and Dr. Florence Mahoney in 1965, the Barthel Index assesses the level of assistance a person requires based on scoring in key areas.

The Barthel Index is a reliable tool for assessing an individual's functional status in geriatric rehabilitation. Additionally, it allows for planning and implementing interventions, and tracking progress. The index incorporates ten ADL skills including feeding, bathing, grooming, dressing, bowel, bladder, toilet use, transfers from bed to chair and back, mobility on level surfaces, and ascending and descending stairs.

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Administering the Barthel Index

Administering the Barthel Index involves a thorough observation and evaluation of an individual’s ability to perform a range of ADLs. In general, as an occupational therapist performing the assessment, therapeutic rapport is first established with the client. 

Subsequently, the therapist explains and observes the client performing each activity. Followed by, scoring, documenting, and interpreting results. Furthermore, the therapist may also share results with the client as well as the healthcare team.

Each item is scored as 0, 5, or 10, with the exception of bowel and bladder control which is scored at either 0 or 10, and total scores range from 0-100. The higher the score, the more independent an individual is at performing ADL tasks. 

Conversely, a lower score suggests a higher need for assistance. The results of the Barthel Index can be used as a valuable tool to evaluate the plan and care of the client. The scoring system can be found below.

 Total scores definition and interpretation:

• 0-20 = Total dependence: The individual relies on assistance to complete most all ADLs.

• 21-60 = Severe dependence: Capable of completing some ADL tasks, but still requires significant assistance for a majority of ADLs.

• 61-90 = Moderate dependence: Will require partial assistance to complete ADL tasks, and/or supervision in more complex activities.

• 90-99 = Slight dependence: Able to complete a majority of tasks independently, however, requires minimal to slight assistance for ADLs under specific conditions.

• 100 = Independent: Can perform all ADL tasks independently.

Challenges and considerations when administering the Barthel Index

Administrating the Barthel Index includes navigating potential challenges and considerations. These may include client cooperation, use of assistive devices, therapist bias, communication barriers, and cultural sensitivity. 

During the assessment period, it may be challenging to obtain all data points due to the client’s health at different points of the day, emotions or feelings toward components of the assessment as well as towards therapy, timing, and environmental considerations in rehabilitation centers vs home. 

Additionally, understanding whether the client utilizes assistive devices is crucial for accurately interpreting their true level of independence. It is also important to factor in therapist bias and if the therapist is providing more or less assistance than necessary. In addition, it is vital to acknowledge the differences in culture and communication among clients and to respect each individual client’s needs.

While there are potential challenges, the Barthel Index serves as a profoundly reliable tool in enhancing the assessment, evaluation, and functional independence of an individual. It serves as a baseline for a client’s functional status and allows for individualized treatment planning as it provides insight into the functioning of specific ADLs, identifies target areas for improvement, monitors progress, allows for goal setting, and provides a universal language for communication amongst healthcare professionals.

Documenting the Barthel Index

Meticulous documentation and reporting of the Barthel Index provide a standardized method to evaluate an individual’s functional activity level. It is a crucial aspect of the therapy process and provides an effective means of communication among the healthcare team, enhances treatment planning, and effective progress monitoring of the client. 

Proper documentation entails: 

• Pertinent medical history of the client
• Purpose of the assessment
• Methods of assessment including date
• Use of assistive devices
• Environmental context
• Description of activities 

It is also important to note the score of each ADL and skilled observations for each of the activities specifically including the level of assistance required. In addition, it is vital to remember that the Barthel Index is a measure of what an individual can do and not what they are expected or want to do. It is also imperative to provide a detailed interpretation of the results. Overall, proper documentation of the assessment allows for tailored interventions and client-centered care.

Barthel Index example report

Client information:

• Name:
• DOB:
• Admission Date:
• Medical History:

Purpose of Assessment:

• Utilized and conducted the Barthel Index, a standardized assessment to assess functional independence.

Method of Assessment:

• Evaluator:
• Assessment date:
• Circumstance: Use of assistive devices, caregiver present.

Activities, Observation, and Scoring:

• Feeding=10: Independent
• Bathing=5: Requires moderate assistance (50%)
• Grooming=5: Requires contact-guard assistance for standing grooming tasks.
• Dressing=5: Requires moderate assistance (50%) to complete lower body dressing tasks
• Bowel Control=10: Independent
• Bladder Control=10: Independent
• Toilet Use=5: Requires moderate assistance (50%) for toilet transfers; utilized four-wheeled walker
• Transfers=5: Requires moderate assistance (50%) for transfers to and from bed/chair; utilized four-wheeled walker
• Mobility=5: Requires contact-guard assistance; utilized four-wheeled walker
• Stair negotiation=5: Requires minimal assistance

Total Score=65: Client is moderately dependent on completing ADL tasks.

A total score of 65 indicates the client requires moderate dependence to complete ADL tasks overall. Specifically, the client requires moderate assistance during bathing, contact-guard assistance with standing grooming tasks including brushing teeth, moderate assistance with dressing, toilet transfers, transfers to and from bed to chair, contact-guard assistance for mobility, and minimal assistance for ascending/descending stairs.

Based on the scores reports and data provided above, goal setting can be established. In this case scenario, goals can be centered around increasing independence with transfers, mobility, stair negotiation, bathing, grooming, and the factors impeding their performance such as range of motion, endurance, or strength. 

In addition, discussing the results with the patient allows for improved patient-centered care and collaboration with goal setting.