The Barthel scale or Barthel ADL index is a scale used to measure performance in basic Activities of Daily Living. The Barthel Index is an ordinal scale. Each performance item is rated on this ordinal scale with a given number of points assigned to each level or ranking.[1]It uses ten variables describing activities of daily living (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. [2]
The scale was introduced in 1965,[3] and yielded a score of 0-20. Although this original version is still widely used, it was modified by Granger et al. in 1979, when it came to include 0-10 points for every variable,[4] and further refinements were introduced in 1989.[5] The Barthel index signifies one of the first contributions to the functional status literature and it represents Occupational Therapists' lengthy period of inclusion of functional mobility and ADL measurement within their scope of practice.[1] The scale is regarded as reliable, although its use in clinical trials in stroke medicine is inconsistent.[6] 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 demonstrated high interrator reliability (0.95) and test re-test reliability (0.89) as well as high correlations (0.74-0.8) with other measures of physical disability.[1]
The ten variables addressed in the Barthel scale are[3]: