Barthel Index (Modified 20 Point Version)

Assesses functional independence, usually with stroke patients.
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 percent of the effort.
7. Use of aids to be independent is allowed.
Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Medical Journal 1965;14:56-61.
Loewen SC, Anderson BA. “Predictors of stroke outcome using objective measurement scales.” Stroke. 1990;21:78-81.
Gresham GE, Phillips TF, Labi ML. “ADL status in stroke: relative merits of three standard indexes.” Arch Phys Med Rehabil. 1980;61:355-358.
Collin C, Wade DT, Davies S, Horne V. “The Barthel ADL Index: a reliability study.” Int Disability Study.1988;10:61-6

1. Bowels

2. Bladder

3. Grooming

4. Toilet Use

5. Feeding

6. Transfer (bed to chair and back)

7. Mobility

8. Dressing

9. Stairs

10. Bathing


Jeff is the lead writer for and covers all things Occupational Therapy. Buy me a Bubble Tea: Venmo @otdude