Barthel's index of activities of daily living is a tool used to assess the degree to which someone is able to care for themselves (functional independence).

Activities of daily living involve items such as bathing, toileting, grooming, feeding, and physical abilities.

The questions are to be answered based upon how the patient is actually functioning currently, not based upon what their ability might be.

The score is between 0 and 20.   The higher the score, the more able the patient is to care for their own activities of daily living.   This score is also used to track improvement or decline over time.

10 questions are asked:

1. Bowel status (preceding week)
   • 0 point = Incontinent (or needs enema)
   • 1 point = Occasionally incontinent
   • 2 points = Fully continent
2. Bladder status (preceding week)
   • 0 point = Incontinent or catheterized and unable to manage
   • 1 point = Occasional incontinence (max 1 per 24 hrs)
   • 2 points = Fully continent (>7 days)
3. Grooming (preceding 24-48 hours)
   • 0 point = Needs help with personal care (face/hair/teeth/shaving)
   • 1 point = Independent
4. Toilet use
   • 0 point = Dependent
   • 1 point = Needs some help but can do some alone
   • 2 points = Independent (getting on/off toilet, wiping, dressing)
5. Feeding
   • 0 point = Unable
   • 1 point = Needs help in cutting, spreading butter, etc
   • 2 points = Independent (provided food is in reach)
6. Transfer (from bed to chair and back)
   • 0 point = Unable (no sitting balance)
   • 1 point = Major help (physical/1-2 people assist)
   • 2 points = Can sit with minor help (verbal or physical)
   • 3 points = Independent
7. Mobility
   • 0 point = Immobile
   • 1 point = Wheelchair-independent (including corners, doors, unaided)
   • 2 points = Walks with help of one person (verbal or physical) or needs supervision
   • 3 points = Independent (may use walking aid)
8. Dressing
   • 0 point = Dependent
   • 1 point = Needs help but can do about ½ unaided
   • 2 points = Independent (including buttons/zips/laces)
9. Stairs
   • 0 point = Unable
   • 1 point = Needs help (verbal/physical/carrying aid)
   • 2 points = Independent (up & down)
10. Bathing
    • 0 point = Dependent
    • 1 point = Independent bathing or showering

References:

1. Collin C, Wade DT, Davies S, et al. The Barthel ADL Index: a reliability study. Int Disabil Stud . 1988;10(2):61-3.
2. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J . 1965;14:61-5.
3. Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud . 1988;10(2):64-7.