Barthel Index (Modified)：Activity of Daily Living

(Reference: Shah, S., Vanclay, F., & Cooper, B. Improving the sensitivity of the Barthel Index for stroke
rehabilitation. Journal of Clinical Epidemiology, 42, 703-709. )
Assessment guidelines and scoring criteria
Functio Description Date Date Dat
n e

Feeding The patient can feed self from a tray or table when 10 10 10
someone puts the food within reach. The patient use
chopsticks and fill a cup from a flask.
Independent in feeding but unable to use chopsticks. 8 8 8
Meat may be cut. Presence of another person is not
required.
The patient feed self in a messy manner. Supervision is 5 5 5
required and someone needs to get him or her a drink.
Someone must provide active assistance during the 2 2 2
meal.
Dependent in all aspects and needs to be fed 0 0 0
Persona The patient can wash his/her hands and face, comb hair, 5 5 5
l clean teeth and shave.
Hygiene The patient is able to conduct his/her own personal 4 4 4
hygiene but requires minimal assistance before and/or
after the operation.
Some assistance is required in one or more steps of 3 3 3
personal hygiene.
Assistance is required in all steps of personal hygiene. 1 1 1
The patient is unable to attend to personal hygiene, and 0 0 0
is dependent in all aspects.
Bathing The patient may use a bath tub, a shower, or take a 5 5 5
Self complete sponge bath. The patient must be able to do all
the steps of whichever method is employed without
another person being present.
Supervision is required for safety in the transfer. 4 4 4
Assistance is required with either transfer to shower/bath 3 3 3
or with washing or drying.
Assistance is required in all aspects of bathing. 1 1 1
Total dependence in bathing self. (Shower: unsupervised/ 0 0 0
unaided)
Toilet The patient is able to get on and off the toilet, fasten and 10 10 10
Use unfasten clothes, prevent soiling of clothes and use toilet
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 paper without help. If necessary, the patient may use a
bed pan or commode, or urinal at night, but must be able
to empty it, and clean it.
Supervision may be required for safety with normal toilet. 8 8 8
A commode may be used at night but assistance is
required for emptying and cleaning.
Assistance may be required with management of 5 5 5
clothing, transferring, or washing hands.
Assistance required in all aspects of toileting. 2 2 2
Fully dependent in toileting 0 0 0
Dressin The patient is able to put on, remove, and fasten 10 10 10
g clothing, tie shoelaces, or put on, fasten, remove splint,
sling as prescribed.
Only minimal assistance is required with fastening 8 8 8
clothing, such as buttons, zips, straps etc. Independence
is achieved with minor adaptation in the clothing.
Assistance is needed in putting on, and/or removing any 5 5 5
clothing.
The patient is able to participate to some degree, but is 2 2 2
dependent in all aspects of dressing.
The patient is dependent in all aspect of dressing and is 0 0 0
unable to participate in the activity.
Bowels The patient can control bowels and has no accidents, can 10 10 10
use suppository, or take an enema when necessary.
The patient may require supervision with the use of 8 8 8
suppository or enema and has occasional accidents.
The patient can assume appropriate position, but cannot 5 5 5
use facilitatory techniques, or clean itself without
assistance and has frequent accidents.
The patient needs help to assume appropriate position, 2 2 2
and with bowel movement facilitatory techniques.
The patient is bowel incontinent. 0 0 0
Bladder The patient is able to control bladder day and night, 10 10 10
and/or is independent with internal and external devices.
The patient is generally dry by day and night, but may 8 8 8
have an occasional accident, or need minimal assistance
with internal and external devices.
The patient is generally dry by day but not at night, and 5 5 5
needs some assistance with the devices.
The patient is incontinent but is able to assist with the 2 2 2
application of an internal or external device.
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 The patient is dependent in bladder management, is 0 0 0
incontinent, or has indwelling catheter.
Bed The patient can safely approach the bed in a w/c, lock 15 15 15
Chair the brakes, life the footrest, move safely to bed, lie down,
Transfer come to a sitting position on the side of the bed, change
the position of the w/c, transfer back into it safely. The
patient must be independent in all phases of this activity.
The presence of another person is required either as a 12 12 12
confidence measure, or to provide supervision for safety.
The transfer requires the assistance of one other person. 8 8 8
Assistance may be required in any aspect of the transfer.
Able to participate but maximum assistance of one other 3 3 3
person is required in all aspects of the transfer.
Unable to participate in a transfer. 2 attendants are 0 0 0
required to transfer the patient with or without a
mechanical device.
Ambulat The patient must be able to wear braces if required, lock 15 15 15
ion and unlock these braces, assume standing position, sit
down, and place the necessary aids into position for use.
The patient must be able to use crutches, canes and walk
50 meters/yards without help or supervision.
The patient is independent in ambulation but unable to 12 12 12
walk 50 yards / meters without help, or supervision is
needed for confidence or safety in hazardous situations.
Assistance is required with reaching aids and/or their 8 8 8
manipulation. One person is required to offer assistance.
Constant presence of one or more assistants is required 3 3 3
during ambulation.
Dependent in ambulation 0 0 0
Wheelch To propel wheelchair independently, the patient must be 5 5 5
air able to go around corners, turn around, manoeuver the
Manage chair to a table, bed, toilet, etc. The patient must be able
ment to push a chair at least 50 metres/yards.
(Alterna The patient can propel self for a reasonable duration over 4 4 4
tive to regularly encountered terrain. Minimal assistance may
ambulat still be required in‘tight corners’.
ion) Presence of one person is necessary and constant 3 3 3
assistance is required to manipulate chair to table, bed
Only use etc.
this Patient can propel self short distances on flat surface, but 2 2 2
item if assistance is required for all other steps of wheelchair
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 the management.
patient Dependent in wheelchair ambulation. 1 1 1
is rated
‘0’for
Ambulat
ion, and
only if
the
patient
has
been
trained
in
wheelch
air
manage
ment

Climbin Patient is able to go up/ down a flight of stairs safely 10 10 10

g stairs without help or supervision. The patient is able to use
hand rails, cane, or crutches when needed and is able to
carry these devices as he/she ascends or descends.
(+/- Generally no assistance is required. At times, supervision 8 8 8
Walking is required for safety due to morning stiffness, shortness
Aids) of breath, etc
Patient is able to go up/down a flight of stairs, but is 5 5 5
unable to carry walking aids, and needs supervision and
assistance. (handrail may be required)
Assistance is required in all aspects of stair-climbing, 2 2 2
including assistance with walking aids.
Patient is unable to participate in stairs climbing despite 0 0 0
much assistance.

Total Value
0-20 = Total dependence
21-60 = Severe dependence
61-90 = Moderate dependence
91-99 = Slight dependence
100 = Independence

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