Barthel Index Calculator

The Barthel Index is a simple and widely used method of measuring the need for assistance with activities of daily living. Clinicians assess ten basic activities of daily living and add up points to give an overall score between 0 and 100.

A higher score indicates greater independence. First published in 1965, it is still used today as a standard assessment tool for stroke care, rehabilitation and geriatric nursing more than half a century later.

The ten activities that are assessed in the index:

The index assesses ten everyday tasks related to nutrition, personal care, bowel control and mobility. The assessment is not based on what a person might be able to do on a good day but rather how they actually get on.

It is important to note that the individual activities are weighted differently. As mobility and transfers are most important for independent living they each have a maximum score of 15 points while bathing and grooming have a maximum score of 5 points.

The score is calculated like this:

No complex arithmetic calculations are required, just simple addition. Earn the appropriate points for each activity and add up the points from all ten areas.

The scores for each activity are either 0 or 5, so the total score is always a multiple of 5. People who can do all ten activities completely independently get 100 points, while people who need help in all areas get 0 points.

What the total score says:

This score is not usually interpreted as an exact measurement but rather to categorize the degree of dependency. A common breakdown is as follows:

There is one piece of information that's more important than all the others. In most studies, 60 or 61 points are used as a cut-off to distinguish people who need a lot of support from those who can be largely independent. So it makes sense to remember this critical value.

Example calculation

Imagine a patient who is recovering from a stroke. He needs help cutting up food to eat (nutrition: 5 points). He can shower on his own (bathing: 5 points). He can also groom himself (appearance: 5 points), but he needs assistance with dressing, especially fastenings that are difficult for him (dressing: 5 points).

Bowel control is intact (10 points) but there are occasional urinary incontinence episodes (5 points). The toilet can be used independently (10 points). There is some assistance with transfers (10 points), and the person can walk with one attendant (10 points). Stairs require assistance (5 points).

In total this gives: 5 + 5 + 5 + 5 + 10 + 5 + 10 + 10 + 10 + 5 = 70, which corresponds to the category of moderate dependency.

Three versions: The original version, the Colin version and the Shah version.

The Barthel Index does not exist in just one version. The original version created by Mahoney and Barthel in 1965 uses the system of scores from 0 to 100 used in this article. Two later revised versions keep the same ten activities but change how they are scored.

The Collin version rates each item on a 1-point scale with a total score ranging from 0 to 20 points. This is done because the original version's 5-point scale may give the impression of greater accuracy. The Shah version, however, keeps a range of 0-100 but divides each activity into five levels instead of two or three. This allows for smaller changes to be detected and so this version is often preferred in research.

The three versions rate individuals on the same scale so that each version interprets a moderate score as an indication of a moderate condition. The more detailed subdivisions of the Shah and Collin versions are mainly helpful in detecting small changes from week to week.

Why multiple tests?

A single Barthel Assessment is only a snapshot of one particular point in time. The real value comes from re-assessing the same person after several days or weeks. Changes in scores show whether rehabilitation is effective.

This calculation tool allows you to set a later assessment as a reference value (e.g. when leaving the hospital). This way it is possible to check whether the degree of independence has improved, remained stable or deteriorated and whether the patient has been classified into another dependency level.

Who is it suitable for?

This index was originally developed for people with neurological or musculoskeletal problems affecting their limbs and is often used in stroke care. It has also been shown to be effective in Parkinson's disease, brain injury, cancer, COVID-19, after intensive care unit discharge, and assessing older adults.

There is no special training required to use this index; any member of the team from a nurse to a therapist can administer it and it usually takes only a few minutes.

Correct rating:

Be sure to note what the person is actually able to do and not just what they seem capable of doing. If someone needs supervision in order to be safe then this cannot be considered independent living. However, if assistive devices such as canes or handrails are used then this would still be considered independent living.

The assessment should reflect the state at a particular point in time and relate to a condition that is stable over one or two days. If direct observation is not possible, information from patients, family members, and staff should be sought.

What cannot be assessed:

The Barthel Index focuses only on basic activities of daily living and mobility. It does not capture more complex aspects of life such as thinking ability, emotions, shopping, cooking or financial management.

There is also an upper limit. Some people may need help from others even if they get 100 points and have to perform activities that the index does not take into account. Therefore it should be used in combination with other tools such as the Modified Rankin Scale or the Functional Independence Measure, but not alone.

Origin:

Florence Mahoney and Dorothea Barthel introduced the index in 1965 in the "Maryland State Medical Journal" and used it to track patients' progress through rehabilitation. Collin and colleagues improved the rating system in 1988, while Shah and colleagues added a five-point rating in 1989.

This calculator is for general educational purposes only and does not constitute medical advice or diagnosis. Assessing a patient's ability to function and creating a care plan are tasks for qualified clinicians with a comprehensive understanding of the situation. If you have questions about your own care or rehabilitation, please consult your healthcare team.