Let’s think for a moment about what a great majority of people do every day since they wake up. We get up, take a shower and wash up, get dressed, have breakfast, go to work/study, eat… these are apparently simple activities that we have automated and in which we do not usually stop to think.

But these are basic activities that we all have to do simply to stay healthy and have a certain amount of autonomy, and which we have been learning and developing throughout our lives.

However, in some cases (accidents, dementias and other neurological diseases, disability…) it is possible that a person may lose the capacity to do them on his/her own or that he/she may not be able to develop them. Bearing in mind that these are basic skills, this implies that in order to achieve adaptive daily functioning, the subject is going to need assistance to be able to carry them out: he/she is going to have a certain level of dependency, whether it is temporary or permanent.

Assessing when a person is dependent and the degree to which he or she needs specific help is not as simple as it may seem at first glance, but fortunately there are different assessment instruments that allow us to make such an assessment. One of them is the Barthel scale or Index , which we will talk about throughout this article.

The Barthel Index

The Barthel Index or Barthel Scale, which is also sometimes called the Maryland Disability Index, is a rating instrument in the form of a scale widely used by various health care professionals to assess or evaluate a person’s level of independence in performing basic activities.

This measure allows for the assessment of the existence of a physical or neurological disability that represents a difficulty in the performance and accomplishment of fundamental tasks in our daily life.

Specifically, this index assesses the so-called basic activities of daily living , which are understood as the set of actions and activities that a person needs to do in order to maintain adequate self-care and stay healthy and active. In other words, unlike other activities that are more related to the subject’s relationship with the environment around him, the basic activities focus on how the subject maintains himself.

Not being able to carry out these activities is clearly detrimental to the physical and mental integrity of the subject and could even lead to death if not helped.

The application of the Barthel index, which began to be used in hospitals in 1955, seeks to evaluate the performance of a total of ten of these basic activities in such a way that it is observed whether the individual can carry them out without any problem , needs help in a specific way or is totally dependent on external help.

Your total score (maximum 100, minimum 0) gives us a general idea of the need for external support, although each of the items you have available can give us relevant information on which areas or types of activities there are problems or whether a particular type of support can be provided.

It must be taken into account that this index must be passed at the initial moment in order to assess whether or not the subject presents problems in his/her daily life, but also during and after any rehabilitation intervention that is used. This will allow us to see whether or not the intervention has been successful and at what level, as well as to adjust the type and level of assistance provided to the patient’s needs. It is also important to bear in mind that we are evaluating what the subject does, not what he might do .

Basic activities you evaluate

The Barthel Index or Scale assesses, as we have said, a total of ten basic activities of daily life, which can be divided mainly into food, hygiene, movement and sphincter control. The specific activities observed are as follows.

1. Food

This item assesses whether the subject is able to eat on his own. It implies being able to put food in the mouth, chew and swallow . In addition, it is also assessed whether the subject is able to perform actions such as cutting food or pouring water on him/herself, although if he/she cannot do the latter actions he/she will also have a score different from zero (10 if he/she can do everything independently, 5 if he/she needs help to cut, use cutlery, etc.). If he needs complete help to be able to eat, the score is 0.

It is important to keep in mind that what is valued is the act of eating itself: it does not matter for this valuation if the person has cooked the food or another person has prepared and served it to him.

2. Washing/Personal hygiene

This activity involves being able to maintain body hygiene on your own, so that you can shower and clean yourself autonomously.

It also takes into account whether you can get in and out of the bathroom. It is assessed whether he needs help or supervision (0) or if he can do it independently (10) .

3. Dressing

Another basic activity is dressing. Here it is valued if the subject can put on and take off his clothes in an autonomous way and without help (10 points), he has to be helped in some moments but most things he can do by himself (5 points) or he needs someone to help him at all times (0 points).

3. Getting ready

This activity involves in part personal hygiene, and includes actions such as combing, washing face or hands, shaving or makeup . It is assessed whether the subject can do it by himself (10) or needs help to do it (0).

4. Faecal continence/incontinence

On this occasion we are talking about a basic activity in which the subject eliminates the residues of digestion through the faecal route. It is assessed whether the subject is capable of containing the faeces (10 points), whether he/she has any episodes of occasional incontinence or needs help from time to time (5) or whether he/she is incapable of controlling the sphincters on his/her own, having incontinence on a regular basis (0).

This assessment is made taking into account the performance made during the week prior to the assessment .

5. Urinary Continence/Continence

Just as faecal incontinence is assessed, so too is urinary incontinence.

In this sense, also taking into account the performance in the week prior to the evaluation, it will be observed whether the subject can hold urine and/or take care of the functioning of a possible catheter (10 points), if he/she has episodes (maximum 1 daily) of incontinence (5) or if he/she cannot hold urine normally (0 points).

6. Toilet use

Linked to the two previous points, in this case it is assessed whether the subject is able to use the toilets by himself . If he can go to the toilet, take off his clothes, relieve himself and clean himself, it is valued with 15 points.

If it needs help but is capable of cleaning itself, 5 points are valued and if it needs help for both aspects, the item will be valued with 0 points.

7. Moving to a chair or bed

This activity would be among those that value the subject’s ability to move, specifically whether he or she is able to sit or stand up by himself or herself or get in and out of bed.

The subject can be totally independent (15 points), need little help (10 points), need someone specialized and with great strength (something that implies that a great part of the effort is made thanks to such help) to help him although he can remain seated by himself (5 points) or need total help in which either a crane or several people move him and he cannot be seated (0 points).

8. Wandering

Another of the basic activities assessed in the Barthel Index or Scale is the ability to wander and move over short distances . It is assessed whether the subject is able to walk 50 metres without the help of another person or walkers (although he/she may use crutches or canes). If he is capable independently, he is scored with 15 points, if he needs some help or a walker, 10, and if he depends on help to move, he is scored with 0.

In the case of people in wheelchairs who can move around independently with the wheelchair, it is scored with 5 points.

10. Use stairs

In most of our urbanizations and houses we can find stairs, steps and changes in height, so being able to use them is considered a basic activity of daily life when moving.

A subject who can climb or descend stairs autonomously is scored 10 points on this item, if he needs someone to help or supervise him 5 points and if he is not able to use the stairs the item is scored 0 points.

Punctuation and Significance

The Barthel Index or Scale is easy to apply and score . Mainly you have to take into account that the maximum score is 100 (90 in the case of those in wheelchairs) and that each item can be scored with 0, 5 or 10 points. The ten points are given when the subject is totally independent for the action referred to in the item, the five points when he needs help for specific aspects or when he occasionally has difficulties, and the zero points are given when the subject is dependent on that activity.

It should also be noted that some items such as washing or grooming only have scores of 5 (independent) or 0 (dependent), and in cases of moving or wandering a score of 15 is added to reflect that the subject can move without assistance (10 would imply minimal assistance or supervision).

The score obtained from this scale allows us to obtain an idea of the degree of dependence of the subject being assessed .

Scores of 100 imply total independence, and lower scores would reflect increasing dependence on activities of daily living. Scores between 100 and 60 indicate the existence of a slight dependency or need for help, between 55 and 40 a moderate dependency, between 35 and 20 would speak of serious dependency and scores below 20 points would indicate that the subject is totally dependent.

Bibliographic references:

  • Cid-Ruzafa, J. and Damián-Moreno, J. (1997). Assessment of physical disability: the Barthel index. Spanish Journal of Public Health, 71 (2). Madrid, Spain.
  • Barrero Solís, C.L., García Arrioja, S. and Ojeda Manzano, A. (2005). Barthel Index (IB): An essential tool for functional assessment and rehabilitation. Plasticity and Neurological Restoration, 4 (1-2). International Association for Brain Plasticity, A.C.