Barthel Index (BI)

The Barthel Index (BI) serves as a measure of daily living activities in relation to personal care and mobility of the patient. The instrument was developed for chronic patients and long-term hospital patients with paralytic conditions, examining their performance before and after treatment. Barthel Index has been used for such tasks as predicting time needed for rehabilitation and amount of nursing aid required.

Formatting for the Barthel Index includes a 10-item or a 15-item response with a four-point scale. The test takes 5 minutes to complete.

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The Barthel ADL Index: Guidelines

1. The index should be used as a record of what a patient does, not as a record of what a patient could do.
2. The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason.
3. The need for supervision renders the patient not independent.
4. A patient’s performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources, but direct observation and common sense are also important. However direct testing is not needed.
5. Usually the patient’s performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant.
6. Middle categories imply that the patient supplies over 50 per cent of the effort.
7. Use of aids to be independent is allowed


Florence I. Mahoney & Dorothea W. Barthel

Reliability and Validity

The two primary version of the Barthel Index – the 10-item and the 15-item – both received high mark reliability ratings. 0.89 test-retest reliability and 0.95 internal reliability were calculated for the 15-item version by Granger (1979) with higher numbers obtained by Shinar (1987). The 10-item has an alpha internal consistency coefficient of 0.87 to 0.92 reported by Shah. Correlated with a motor ability index, the Barthel Index was given a .73 to .77 rating. The Barthel Index was agreed to be a reliable instrument in foreseeing mortality and easy to use.

Obtaining the Barthel Index

Stroke Center

Administration, Analysis and Reporting

Statistics Solutions consists of a team of professional methodologists and statisticians that can assist the student or professional researcher in administering the survey instrument, collecting the data, conducting the analyses and explaining the results.

For additional information on these services, click here.


Barclay, L., & Vega, C. (2007). Occupational therapy improves personal activities of daily living after stroke. BMJ, 335(7626), 922.

Granger, C.V., Dewis, L.S., Peters, N.C., Sherwood, C.C., & Barrett, J.E. (1979). Stroke rehabilitation: Analysis of repeated Barthel index measures. Archives of Physical Medicine and Rehabilitation 60(1), 14–7.

Mahoney, F.I., & Barthel, D. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 56-61. Used with permission.

Oveisgharan, S., et al. (2006). Barthel Index in a Middle-East country: Translation, validity and reliability. Cerebrovascular Disease, 22, 350-354.

Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology 42(8), 703–709.

Tibaek, S., et al. (2009, May 28). Are activity limitations associated with lower urinary tract symptoms in stroke patients? A cross-sectional, clinical survey. Scandinavian Journal of Urology and Nephrology, 1-7.