Choose the scoring point for the statement that most closely corresponds to the patient's current level of ability for each of the following 10 items. Record actual, not potential, functioning. Information can be obtained from self-report, family/relatives, or direct observation. Refer to the Guidelines below for details on scoring and interpretation.

📊 The Barthel Index (Activities of Daily Living)

Item	0	1	2	3
Bowels	Incontinent (or needs to be given enema)	Occasional accident (once/week)	Continent
Bladder	Incontinent, or catheterised and unable to manage	Occasional accident (max. once/24 hrs)	Continent (for over 7 days)
Grooming	Needs help with personal care	Independent (face/hair/teeth/shaving with implements provided)
Toilet use	Dependent	Needs some help, but can do something alone	Independent (on/off, dressing, wiping)
Feeding	Unable	Needs help cutting/spreading butter, etc.	Independent (food provided within reach)
Transfer	Unable, no sitting balance	Major help (one/two people, physical), can sit	Minor help (verbal or physical)	Independent
Mobility	Immobile	Wheelchair independent, including corners	Walks with help of one person (verbal/physical)	Independent (with aid if needed, e.g. stick)
Dressing	Dependent	Needs help, but can do about half unaided	Independent (including buttons/zips/laces)
Stairs	Unable	Needs help (verbal, physical, carrying aid)	Independent up and down
Bathing	Dependent	Independent (or shower)
Total Score	Sum the patient’s scores across all items. Range: 0 – 20 🔴 Lower scores = more disability 🟢 Higher scores = more independence Interpretation: - 0–4: Severe dependence - 5–9: Moderate dependence - 10–14: Mild dependence - 15–19: Minimal dependence - 20: Independent If measuring improvement after rehab: - A change >2 points = likely genuine - A single-item change from dependent ➝ independent is also significant.

📌 Guidelines for Use

Index reflects what a patient does, not what they could do.
Main aim = establish degree of independence from help (physical or verbal).
Supervision = not independent.
Performance should be based on best available evidence (patient, carers, nurses, observation).
Direct testing not needed — practical judgement applies.
Assess over preceding 24–48 hours (sometimes longer if relevant).
Middle categories imply the patient supplies >50% of the effort.
Use of aids (e.g., walking stick) counts as independent.

Clinical Pearl: The Barthel Index is quick (<10 minutes), reliable, and widely used in stroke, neuro-rehab, and frailty care. It measures functional independence in ADLs, not cognitive or social domains — so it complements, but does not replace, broader assessments (e.g. Lawton IADL or cognitive testing).

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Barthel Index

📊 The Barthel Index (Activities of Daily Living)

📌 Guidelines for Use

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