Barthel Index for Activities of Daily Living (ADL)

Barthel Index for Activities of Daily Living (ADL)

Measures functional independence in basic daily self-care activities

Barthel Index for Activities of Daily Living (ADL)

Barthel Index for Activities of Daily Living (ADL)

Measures functional independence in basic daily self-care activities

Feeding
Ability to eat independently
Bathing
Ability to bathe self
Grooming
Personal care (e.g., washing face, brushing teeth)
Dressing
Ability to dress self
Bowels
Bowel continence
Bladder
Bladder continence
Toilet Use
Ability to use toilet
Transfers
Moving from bed to chair and back
Mobility
Walking on level surface
Stairs
Ability to climb stairs
Barthel Index: 0/100, Total dependence
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Instructions

The Barthel Index is a simple, standardized tool to measure a patient’s ability to perform basic activities of daily living (ADLs) independently. It assesses 10 key domains such as feeding, bathing, mobility, and continence. Each activity is scored according to the level of assistance required, ranging from complete independence to total dependence. The total score helps determine functional status and rehabilitation needs. To administer, observe or ask the patient about their ability in each area, then sum the scores. Use results to guide care planning and monitor progress.

Overview
When to use
Why use
Evidences

Interpretation

Total Score

Dependency Level

100

Independent

85–95

Mild Dependency

65–80

Moderate Dependency

25–60

Severe Dependency

0–20

Total Dependency

 

The Barthel Index (BI) was introduced in 1965 to measure performance in 10 basic activities of daily living (ADLs) and mobility, producing a summed score that reflects a person’s level of independence in self-care and transfers/ambulation
https://www.sralab.org/sites/default/files/2017-07/barthel.pdf

https://pubmed.ncbi.nlm.nih.gov/14258950/

 

The original BI assesses 10 items: feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility, and stairs; items are scored in graded levels of independence and summed (most commonly 0–20 or 0–100 versions), with lower scores indicating greater disability; guidance emphasizes recording what the patient does, not what they could do, and that supervision implies dependence.
https://www.albertahealthservices.ca/assets/about/scn/ahs-scn-bjh-hf-barthel-index-of-adls.pdf

 

A systematic review/meta-analysis of stroke cohorts found excellent inter-rater reliability for standard BI administration (weighted kappa ≈0.93), supporting its use in clinical practice and trials, although study sizes were modest and administration methods varied.
https://www.ahajournals.org/doi/10.1161/strokeaha.112.678615

Overview
When to use
Why use
Evidences

The Barthel Index for Activities of Daily Living is a widely used clinical tool designed to assess a patient’s degree of functional independence. Originally developed in 1965, it provides a quantitative measure of disability by evaluating ten fundamental tasks necessary for daily living. These include feeding, grooming, bathing, dressing, bowel and bladder continence, toilet use, transfers, mobility, and stair climbing.

The index assigns scores based on the degree of assistance needed, ranging from 0 (unable) to higher values indicating independence. The maximum score is 100, representing complete independence. Intermediate values help clinicians and rehabilitation teams categorize patients into levels of dependence, which can guide care planning, rehabilitation interventions, and discharge decisions.

The Barthel Index has been validated across multiple patient populations, particularly in stroke, brain injury, spinal cord injury, and geriatric care. It is sensitive enough to detect changes in functional ability over time, making it useful for monitoring recovery or decline. While it does not directly measure cognitive or emotional factors, it complements other assessments by focusing on physical performance of essential daily tasks.

Overview
When to use
Why use
Evidences

Interpretation

Total Score

Dependency Level

100

Independent

85–95

Mild Dependency

65–80

Moderate Dependency

25–60

Severe Dependency

0–20

Total Dependency

 

The Barthel Index (BI) was introduced in 1965 to measure performance in 10 basic activities of daily living (ADLs) and mobility, producing a summed score that reflects a person’s level of independence in self-care and transfers/ambulation
https://www.sralab.org/sites/default/files/2017-07/barthel.pdf

https://pubmed.ncbi.nlm.nih.gov/14258950/

 

The original BI assesses 10 items: feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility, and stairs; items are scored in graded levels of independence and summed (most commonly 0–20 or 0–100 versions), with lower scores indicating greater disability; guidance emphasizes recording what the patient does, not what they could do, and that supervision implies dependence.
https://www.albertahealthservices.ca/assets/about/scn/ahs-scn-bjh-hf-barthel-index-of-adls.pdf

 

A systematic review/meta-analysis of stroke cohorts found excellent inter-rater reliability for standard BI administration (weighted kappa ≈0.93), supporting its use in clinical practice and trials, although study sizes were modest and administration methods varied.
https://www.ahajournals.org/doi/10.1161/strokeaha.112.678615

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