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'The '''Barthel scale''' or '''Barthel ADL index''' is an [[ordinal scale]] used to measure performance in [[activities of daily living]] (ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking.<ref name="O'Sullivan">{{cite book|last=O'Sullivan|first=Susan B|title=Physical Rehabilitation, Fifth Edition|year=2007|publisher=F.A. Davis Company|location=Philadelphia, PA|pages=385|author2=Schmitz, Thomas J}}</ref> It uses ten variables describing 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 [[wikt:assessment|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.<ref>{{cite web|last=Carroll |first=Douglas |title=Functional Evaluation: The Barthel Index |url=http://www.strokecenter.org/trials/scales/barthel_reprint.pdf |accessdate=12 May 2011 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928032514/http://www.strokecenter.org/trials/scales/barthel_reprint.pdf |archivedate=28 September 2011 |df= }}</ref> The scale was introduced in 1965,<ref name=MahoneyBarthel>{{cite journal | author=Mahoney F. Barthel D | title=Functional evaluation: the Barthel Index | journal=Md Med J | year=1965 | volume=14 | pages=61–65 | pmid=14258950}}</ref> 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,<ref>{{cite journal |vauthors=Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE | title=Stroke rehabilitation: analysis of repeated Barthel index measures | journal=Arch Phys Med Rehabil |date=January 1979 | volume=60 | issue=1 | pages=14–7 | pmid=420565}}</ref> and further refinements were introduced in 1989.<ref>{{cite journal |vauthors=Shah S, Vanclay F, Cooper B |title=Improving the sensitivity of the Barthel Index for stroke rehabilitation |journal=J Clin Epidemiol |volume=42 |issue=8 |pages=703–9 |year=1989 |pmid=2760661 |doi=10.1016/0895-4356(89)90065-6}}</ref> The modified Barthel index was designed as the original scale was insensitive to change and had arbitrary scores. The sensitized version sharply discriminates between good and better and poor and poorer performances. Its effectiveness is not just with in-patient rehabilitation but home care, nursing care, skilled nursing, and community. The Barthel index signifies one of the first contributions to the functional status literature and it represents [[occupational therapist]]s' lengthy period of inclusion of functional mobility and ADL measurement within their scope of practice.<ref name="O'Sullivan"/> The scale is regarded as reliable, although its use in [[clinical trial]]s in [[stroke]] medicine is inconsistent.<ref>{{cite journal |vauthors=Sulter G, Steen C, De Keyser J |title=Use of the Barthel index and modified Rankin scale in acute stroke trials |journal=Stroke |volume=30 |issue=8 |pages=1538–41 |date=August 1999 |pmid=10436097 |doi= 10.1161/01.str.30.8.1538|url=http://stroke.ahajournals.org/cgi/content/full/30/8/1538}}</ref> 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 been shown to have portability and has been used in 16 major diagnostic conditions. The Barthel index has demonstrated high [[inter-rater reliability]] (0.95) and [[test–retest reliability]] (0.89) as well as high correlations (0.74–0.8) with other measures of physical disability.<ref name="O'Sullivan"/> Copyright Information: The Maryland State Medical Society holds the copyright for the Barthel Index. It may be used freely for noncommercial purposes with the following citation: Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14:56-61. Used with permission. Permission is required to modify the Barthel Index or to use it for commercial purposes. The ten variables addressed in the Barthel scale are:<ref name=MahoneyBarthel/> * Presence or absence of [[fecal incontinence]] * Presence or absence of [[urinary incontinence]] * Help needed with grooming * Help needed with toilet use * Help needed with feeding * Help needed with transfers (e.g. from chair to bed) * Help needed with walking * Help needed with dressing * Help needed with climbing stairs * Help needed with bathing ==See also== * [[Modified Rankin Scale]] ==References== {{reflist}} ==External links== * [http://www.pmidcalc.org/14258950 1965 (original version) online calculator at pmidcalc.org] * [http://www.strokecenter.org/wp-content/uploads/2011/08/barthel.pdf Stroke Center reprint] [[Category:Rehabilitation medicine]] [[Category:Medical scales]] [[Category:Occupational therapy]]'