Psychology RootsBarthel Index (Formerly the Maryland Disability Index)
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About Barthel Index (Formerly the Maryland Disability Index)
Scale Name
Barthel Index (Formerly the Maryland Disability Index)
Author Details
Florence I. Mahoney and Dorothea W. Barthel
Translation Availability
English
Background/Description
The Barthel Index (BI), originally developed by Mahoney and Barthel in 1955 and published in 1965 in the Maryland State Medical Journal, is a 10-item clinician-rated scale designed to assess functional independence in activities of daily living (ADLs) among adults with physical disabilities, particularly those with neurological or musculoskeletal conditions (e.g., stroke, spinal cord injury). Previously known as the Maryland Disability Index, the BI evaluates 10 domains: Feeding, Bathing, Grooming, Dressing, Bowel Control, Bladder Control, Toilet Use, Transfers (bed to chair), Mobility (walking or wheelchair use), and Stair Climbing. It is widely used to measure rehabilitation outcomes and predict care needs.
Each item is rated based on the level of assistance required, using a weighted scoring system (0, 5, 10, or 15 points, depending on the item and independence level). Total scores range from 0–100, with higher scores indicating greater independence (0 = fully dependent, 100 = fully independent). The BI was validated with 150 rehabilitation patients (mean age ≈ 50–70 years, mixed gender, U.S.-based), showing that scores ≥60 predict discharge to home. It correlates with the Functional Independence Measure (r ≈ 0.80–0.90) and PULSES Profile (r ≈ 0.70–0.85). The BI is used in rehabilitation medicine, geriatrics, and clinical psychology to assess ADL performance, monitor recovery, and guide treatment planning. The scale is freely available with permission from the original publication.
Administration, Scoring and Interpretation
- Obtain the BI from Mahoney and Barthel (1965) or authorized sources (e.g., Maryland State Medical Journal), ensuring ethical permissions.
- Explain to participants (adults with physical disabilities) or caregivers that the scale assesses daily functioning, emphasizing confidentiality and voluntary participation.
- Administer the 10-item scale in a clinical or rehabilitation setting via observation and interview, rating each ADL based on the patient’s current performance.
- Estimated completion time is 5–10 minutes (2–5 minutes for direct observation, longer with interviews).
- Ensure a private, supportive environment; provide rehabilitation resources (e.g., support services) and adapt for accessibility (e.g., simplified instructions) if needed.
Reliability and Validity
The BI demonstrates robust psychometric properties (Mahoney & Barthel, 1965; Granger et al., 1979). Inter-rater reliability is high (r ≈ 0.87–0.95), supported by standardized scoring criteria across 100–200 patient samples. Test-retest reliability is strong (r ≈ 0.80–0.90 over 1–2 weeks). Internal consistency is moderate to high (Cronbach’s alpha ≈ 0.85–0.90).
Convergent validity is evidenced by correlations with the Functional Independence Measure (r ≈ 0.80–0.90), PULSES Profile (r ≈ 0.70–0.85), and Katz Index of ADL (r ≈ 0.75–0.85). Criterion validity is shown by its ability to predict rehabilitation outcomes (e.g., discharge to home for scores ≥60) and sensitivity to functional changes post-intervention. Discriminant validity is supported by weak correlations with cognitive measures (r < 0.20). The BI’s unidimensional structure focuses on physical functioning. Pairing with measures like the Functional Independence Measure or Lawton IADL Scale enhances comprehensive assessment.
Available Versions
10-Items
Reference
Fi, M. (1965). Functional evaluation: the Barthel index. Maryland state medical journal, 14, 61-65.
Granger, C. V., Albrecht, G. L., & Hamilton, B. B. (1979). Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Archives of physical medicine and rehabilitation, 60(4), 145-154.
Important Link
Scale File:
Frequently Asked Questions
What does the Barthel Index measure?
It measures functional independence in 10 activities of daily living for adults with physical disabilities.
Who is the target population?
Adults with neurological or musculoskeletal conditions in rehabilitation settings.
How long does it take to administer?
Approximately 5–10 minutes.
Can it inform interventions?
Yes, it assesses ADL performance to guide rehabilitation and predict care needs.
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