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Barthel Index

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Barthel Index Infographic

Purpose

The BI assesses the ability of an individual with a neuromuscular or musculoskeletal disorder to care for him/herself.

Link to Instrument

Instrument Details

Acronym BI

Area of Assessment

Activities & Participation
Bodily Functions

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Contact information and permission to use:

MAPI Research Trust, Lyon, France:

E-mail: PROinformation@mapi-trust.org
Internet: www.mapi-trust.org
Information on Barthel Index: http://www.mapi-trust.org/services/questionnairelicensing/catalog-questionnaires/212-barthelindex

Diagnosis/Conditions

  • Brain Injury Recovery
  • Stroke Recovery

Populations

Brain Injury
Mixed Conditions
Neurologic Conditions
Stroke

Key Descriptions

  • 10 ADL/mobility activities including:
    1) Feeding
    2) Bathing
    3) Grooming
    4) Dressing
    5) Bowel control
    6) Bladder control
    7) Toileting
    8) Chair transfer
    9) Ambulation
    10) Stair climbing
  • Items are rated based on the amount of assistance required to complete each activity.

Number of Items

10

Time to Administer

20 minutes

Self-Report: 2-5 minutes
Direct Observation: 20 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitaton Measures Team in 2010; Updated by Kelly Askins, SPT and Holly Ford, SPT with stroke and elderly populations in 2011; Updated with references for the TBI population by Tammie Keller, PT, DPT, MS and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

Updated in 2019 by Mia DiGiacomo OTS, UIC, Shelby Harter OTS, UIC, Kara Stone OTS, UIC, & Allie Ward OTS, UIC and reviewed in 2020 by Toqa Afifi, Cornell University

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: ANPT Outcome Measures Recommendations (EDGE)

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled

Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

LS

R

LS

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

NR

LS

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

No

Yes

Not reported

Considerations

There are several possible scoring techniques for the BI. The method of obtaining the information does not appear to be important, but allowance needs to be made for confused patients if self-reporting is used. (Collin et al, 1988) The BI, FIM, FIM+FAM have similar measurement properties for activities of daily living and functional mobility (Hobart et al., 2001) “The results of this study would support considering the use of scales other than the Barthel Index when describing disability following traumatic head injury.” It looks at the physical aspect almost exclusively and does not consider the psychological (McPherson et al., 1997). This measure has demonstrated good responsiveness and adequate floor and ceiling effects in more acutely involved individuals. May be less effective in a chronic or highly mobile patient population. “In 1983, the 18-item Functional Independence Measure (FIM)5 was developed because the BI was considered too restricted and poorly responsive “.(Hobart et al., 2001)

Barthel Index translations:
Chinese: http://rehabsociety.org.hk/e/customize/images/pdf/中文版Barthel%20Index%20評級標準.pdf
Danish: http://fysio.dk/fafo/Maleredskaber/Maleredskaber-alfabetisk/Barthel-Indeks-/
French: https://www.cofemer.fr/cofemer/ckeditorImage/Files/Barthel2.pdf
German: http://www.praxis-wiesbaden.de/icd10-gm-diagnosen/zusatz-barthelindex.php
Italian: http://www.iss.it/binary/publ/cont/08-39%20web.1233562284.pdf
Korean: http://webcache.googleusercontent.com/searchq=cache:uZfd1yxOtQoJ:cfile206.uf.daum.net/attach/112  
These translations, and links to them, are subject to theTerms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

 

Brain Injury

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Standard Error of Measurement (SEM)

Brain injury: (Liu, 2004; n=175 with n=101 with vascular brain injury, n=49 with traumatic brain injury, n=27 with other brain injuries; median age=45, inpatient rehabilitation; length of stay=95 days).

 

Admission

Median (IQR)

Mean (SD)

Discharge

Median (IQR)

Mean (SD)

Barthel Index

11 (6,11)

10.7 (6.2)

15 (12, 19)

14.1 (5.6)

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Brain injury: (Liu, 2004; n=175 with n=101 with vascular brain injury, n=49 with traumatic brain injury, n=27 with other brain injuries; median age=45, inpatient rehabilitation; length of stay=95 days).

  • Adequate predictive validity: The admission score on the Barthel was predictive of the discharge score. The lower the admission score, the greater the change with rehabilitation. (Rho=-0.42)

Responsiveness

Brain injury: (Liu, 2004; n=175 with n=101 with vascular brain injury, n=49 with traumatic brain injury, n=27 with other brain injuries; median age=45, inpatient rehabilitation; length of stay=95 days).

 

Change Median (IQR); Mean (SD)

Z-score; p -value

Barthel Index

+3 (+1, +5) ;+3.5 (3.4)

-10.2; P <0.000

Mixed Conditions

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Minimally Clinically Important Difference (MCID)

Inpatient rehab: (Castiglia et al., 2017; n=53; mean age 72.71 (12.79); orthopedic diseases n=21; PD or stroke n=32; mean hospital duration: 45.11(16.53) days, Italian version)

  • MCID = 35 points
  • Sensitivity = 0.65; specificity = 0.75

Normative Data

Inpatient rehab: (Castiglia et al., 2017)

  • Mean IcaBI (Italian version of the Barthel Index) scores at admission: 43.7(22.9)
  • Mean IcaBI scores at discharge: 80.5(21.5)

Interrater/Intrarater Reliability

Neurologic Rehab Patients: (Rollnik et al., 2011; n = 273)

  • Excellent: Inter-rater reliability (r = 0.849, p < 0.001). The findings suggest that the Early rehabilitation Barthel Index (ERBI) is a reliable and valid scale to assess early neurological rehabilitation patients (Modified version of BI)

Inpatient Rehab: (Castiglia et al., 2017; n = 48, mean age = 73.79 (9.9); orthopedic diseases n = 22; stroke or Parkinson’s disease n = 26, Italian version of BI)

  • Adequate to Excellent interrater reliability (ICC range from 0.74-0.96 depending on item)
  • Moderate to substantial interrater agreement (Cohen’s K value range from 0.64-0.85 depending on item)

Internal Consistency

Neurologic Rehabilitation: (Hobart et al., 2001; n=149; female= 81; mean age= 46.2 (14.8) ; stroke n=45, head injury n=9, MS n=64, other n=34)

  • Excellent internal consistency alpha = 0.94*

Inpatient Rehab: (Castiglia et al., 2017; n=264; mean age 73.84 (13.3); internal diseases (cardiorespiratory, metabolic, oncological, urological) n=115; neurological disorders (Parkinson’s disease, stroke) n=83; orthopedic pathologies (hip/femur surgery, knee surgery, vertebral problems w/o neurological sequelae) n=66, Italian version)

  • Excellent: Cronbach’s alpha = 0.94*
  • Excellent: when item 1 (“feeding”) removed, Cronbach’s alpha = 0.95*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Construct Validity

Neurologic Rehabilitation: (Hobart et al., 2001; n=149; female= 81; mean age= 46.2 (14.8) ; stroke n=45, head injury n=9, MS n=64, other n=34)

  • Excellent correlations between the Office of Population Census and Surveys (OPCS, n = 69) disability measure and the 10-item BI, FIM motor, and FIM + FAM motor scales (r = 0.84) for all 3 scales

Content Validity

  • The bladder item for the Barthel Index had fit residuals greater than 2, indicating the likely measurement of another construct (de Morton et al, 2008)
  • Multiple items indicated item redundancy and observed proportions deviated significantly from the Rasch model (de Morton et al, 2008)

Responsiveness

Neurological rehab patients : (Houlden, 2006; n=259 vascular brain injury due to single cerebral infarction (n = 75), spontaneous intracerebral haemorrhage (n = 34) and subarachnoid haemorrhage (n = 43), and 107 patients who had sustained traumatic brain injury, setting= regional neurologic rehabilitation unit)

  • Highly responsive to detecting changes:
    • In all patient groups there was a significant improvement (Wilcoxon's rank sum, P<0.0001) in the Barthel Index (mean change score: vascular 3.9, traumatic 3.95). Barthel Index (effect size: vascular 0.65, traumatic 0.55)

Inpatient rehab: (Castiglia et al., 2017; n=53; mean age 72.71 (12.79); orthopedic diseases n=21; PD or stroke n=32; mean hospital duration: 45.11(16.53) days, Italian version)

  • Adequate: AUC = 0.72

Mixed Conditions

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Standard Error of Measurement (SEM)

Older Adults in Nursing Homes: (Bouwstra et al., 2018; n=244; mean age: 77 (9.7) Years, Collin and Wade’s BI)

  • SEM =  1.1 points

 

Minimal Detectable Change (MDC)

Older adults in Nursing Homes: (Bouwstra et al., 2018)

  • MDC = 3.0 points

 

Older Adults Acutely Hospitalized: (Wales et al. 2018; n=66; mean age = 78.05 (4.13) years; currently hospitalized)

  • MDC = 27.26 

 

Minimally Clinically Important Difference (MCID)

Older Adults with Femoral Neck Fracture: (Unnanuntana et al., 2018; n = 81; mean age = 76.0 (8.2) years; 2 weeks, 3 months, and 12 months post-op)

  • MCID = 9.8 points

Cut-Off Scores

Older Adults with Hip Fracture: (Gonzalez et al, 2017; n=1094; mean age=76.6 (7) years)

  • <85 indicates risk of mortality 6 months post fracture (sensitivity: 63.64%, specificity: 64.77%)

Normative Data

Older Adults in a Nursing Home: (Bouwstra et al., 2018, Collin & Wade’s BI)

  • Median score at admittance: 11
  • Median score at discharge: 16.3
  • Mean change score between assessments: 4.8 (4.0)

 

Older Adults with Fractures: (Gonzalez et al., 2018)

Cohort 1: Hip Fracture (Mean (SD))*

Injury outcome:

Worsened (n = 429)

Unchanged (n = 278)

Baseline

90.13 (15.92)

77.41 (29.40)

Follow-Up

61.46 (30.25)

65.31 (36.73)

Change

-28.87 (25.59)

-11.91 (21)

 

Cohort 2: Wrist Fracture (Mean (SD))*

Injury outcome:

Worsened (n  = 226)

Unchanged (n  = 631)

Baseline

94.19 (14.33)

95.46 (12.54)

Follow-Up

80.80 (24.88)

93.90 (15.79)

Change

-13.30 (19.54)

-1.43 (10.29)

*The worsened and unchanged groups were derived from the change score calculated in the Lawton-Brody Index (LBI). Patients with LBI at baseline equal or lower than at follow-up were classified as “unchanged or improved”. Patients with LBI at baseline higher than at follow-up were considered “worsened”.

 

Outpatient Rehabilitation - Older Adults: (Hormozi, et al., 2019; n=395; mean age = 67.3 (6.04), Iranian version)

  • Mean BI Score: 73.25 (SD = 31.55)
  • 41.3% were fully independent and scored 100 points; 15.4% were physically dependent in at least one area
  • Mean BI score for those with arthritis: 85
  • Mean BI score for those with stroke: 67
  • Mean BI score for those with falling: 70
  • Mean BI score for those with incontinence: 77

 

Osteoporotic Hip Fracture:

(Mayoral, et al., 2019; n = 208; 1, 3, and 6 months post-injury; Spanish sample)

Type of complication 

BI mean at hospital admission

BI mean 1 year after fracture

Without complications

89.4

93.9

Superficial wounds or infections

88.3

83.8

Heart failure

62.5

76.7

Lung failure

88.0

90.0

Delirium

57.2

60.4

Mental confusion

85.0

81.0

Urinary incontinence

89.1

88.6

Decubitus

40.0

0.0

Kidney failure

65.0

67.5

Multiple complications

63.0

61.9

 

Community-Dwelling Elderly People in Japan:

(Saito et al., 2016; n = 346; Mean Age = 76.0 (6.9); Japanese sample)

  • Mean BI score (HE group): 99.4 ± 2.1
  • Mean BI score (FE group): 83.6 ± 18.2

 

Older Adults with Femoral Neck Fracture: (Unnanuntana et al., 2018; n = 81, mean age = 76.0 (8.2), female = 69 (85.2%), patients who underwent hemiarthroplasty to treat femoral neck fracture)

Time Interval

Baseline

3 months post-op

12 months post-op

Barthel Index Score

58.9 (15.7)

           86.2

           92.5

  • Baseline range = 15-95 (80)
  • Baseline median (IQR) = 60 (50, 70)

 

Hospitalized Older Adults:  (Wales et al., 2018)

  • Baseline mean: 68.64 (16.77)
  • Baseline range: 25-100

Test/Retest Reliability

Outpatient Rehabilitation - Older Adults: (Hormozi, et al., 2019)

  • ICC = .936 (95% CI: .895-.965)

Interrater/Intrarater Reliability

Elderly: (Richards et al, 1998; n = 94; mean age = 78.4 years)

  • Fair to Good interrater reliability depending on the activity assessed.

Older Adults in a Nursing Home: (Bouwstra et al., 2018)

  • Excellent reliability: 0.96

Internal Consistency

Older Adults in Nursing Homes: (Bouwstra et al., 2018)

  • Excellent: Cronbach’s alpha = .83

 

Older Adults with Hip or Wrist Fracture: (Gonzalez et al., 2017; 

n=2102; Mean Age: 80.1 (7.02) years)

  • Excellent: Cronbach’s alpha = .91-.92*


Older Adults in Residential Care Settings: (Gonzalez et al.,

 2017; n=234; Mean Age: 81 (7.06) years)

  • Excellent: Cronbach’s alpha = .92*


Community-Dwelling Older Adults: (Gonzalez et al., 2017; n=1106; Mean Age: 72.07 (7.83) years)

  • Excellent: Cronbach’s alpha = .88-.92*

 

Geriatric Outpatients: (Hormozi, et al., 2019)

  • Excellent: Cronbach’s alpha = .938*, p<.001
  • Item- Total Correlation (ITC) - Cronbach’s alpha* if Item Deleted:
    • Bowel: .936
    • Bladder: .933
    • Grooming: .932
    • Toilet use: .924
    • Feeding: .930
    • Transfer: .924
    • Mobility: .920
    • Dressing: .928
    • Stairs: .930
    • Bathing: .931

 

Hospitalized older adults: (Wales et al., 2018)

  • Poor Cronbach’s alpha = .66
  • “Tools showed poor-to-excellent internal consistency (α = 0.27–0.92*).”

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Criterion Validity (Predictive/Concurrent)

Predictive validity: 

Older Adults with Hip Fracture: (Gonzalez et al., 2018)

  • Excellent correlation between BI score and mortality (r = .67)

Construct Validity

Older Adults with Hip and Wrist Fracture: (Gonzalez et al., 2017; n=2102; mean age: 80.1 (7.06) years)

Convergent validity 

  • Excellent correlation between LBI and Barthel Index (r = .76 and .58)
  • Excellent correlation between FD-W and Barthel Index (r = .73)
  • Adequate correlation between PCS-12 and Barthel Index (r =.57) 

Discriminant validity

  • Poor correlation between MCS-12 and Barthel Index (r = .20)
  • Poor correlation between PD-W and Barthel Index (r = -.25)

 

Community-Dwelling Older Adults:  

Discriminant validity (Gonzalez et al., 2017; n=1106; mean age: 72.07 (7.83) years)

  • Poor correlation between DUFFS and Barthel Index (r=.10)

 

Community-Dwelling Elderly People in Japan

Convergent validity (Saito et al., 2016)

  • Poor correlation with FIDS (r = 0.25) in HE group
  • Excellent correlation with FIDS (r = 0.81) in FE group

 

Older Adults with Femoral Neck Fracture: 

Convergent validity (Unnanuntana et al., 2018) 

  • Adequate to Excellent correlation with DEMMI at baseline, 3-months, and 12 months post-op (r = 0.580, 0.688, 0.678)
  • Poor to Adequate correlation with EQ-VAS at baseline, 3-months, and 12-months post-op (r = 0.278, 0.323, 0.317)
  • Adequate to Excellent correlation with 2-min walk test at baseline, 3-months, and 12-months post-op (r = 0.594, 0.630, 0.651)
  • Adequate to Excellent correlation with TUG at baseline, 3-months, and 12-months post-op (r = -0.490, -0.743, -0.843)

 

Floor/Ceiling Effects

Elderly: (de Morton et al., 2008)

  • The range of person abilities exceeded the range of item difficulty at both ends of the scale
  • The original Barthel Index had a ceiling effect at hospital admission and hospital discharge

Older Adults in a Nursing Home: (Bouwstra et al., 2018)

Floor effect:

  • Adequate: At baseline: 0.5%
  • Adequate: At discharge: 0.6%

Ceiling effect:

  • Adequate: At baseline: 2.0%
  • Poor: At discharge: 22%

 

Older Adults with Fractures: (Gonzalez et al., 2018)

Cohort 1: Hip Fracture*

Injury outcome:

Worsened (n  = 429)

Unchanged (n  = 278)

% at floor

Pre-fracture

0

2.9

Post-fracture

3.7

6.7

% at ceiling

Pre-fracture

50.8

42.3

Post-fracture

11.2

30

 

Cohort 2: Wrist Fracture*

Injury outcome:

Worsened (n  = 226)

Unchanged (n  = 631)

% at floor

Pre-fracture

0

0.2

Post-fracture

1.9

0.2

% at ceiling

Pre-fracture

70.7

78

Post-fracture

35.4

73.9

*The worsened and unchanged groups were derived from the change score calculated in the Lawton-Brody Index (LBI). Patients with LBI at baseline equal or lower than at follow-up were classified as “unchanged or improved”. Patients with LBI at baseline higher than at follow-up were considered “worsened”.

 

Community-Dwelling Elderly People in Japan: (Saito et al., 2016)

Floor Effect:

  • Excellent, no floor effect (0%)

Ceiling Effect:

  • HE group
    • Poor ceiling effect on TMIG-IC score 0-10 (72.0%)
    • Poor ceiling effect on TMIG-IC score 11-12 (88.9%)
    • Poor ceiling effect on TMIG-IC score 13 (94.9%)
  • FE group
    • Adequate ceiling effect on those requiring long-term care 3-5 (4.2%)
    • Poor ceiling effect on those requiring long-term care 1-2 (21.7%)
    • Poor ceiling effect on those requiring support 1-2 (63.2%)

 

Older Adults with Femoral Neck Fracture: (Unnanuntana et al., 2018) 

Floor Effect:

  • Excellent, no floor effect (0% at 3-months and 12-months post-op)

Ceiling Effect:

  • Poor (25.9% 3-months post-op, 51.9% 12-months post-op)

 

Responsiveness

Older Adults with Femoral Neck Fracture: (Unnanuntana et al., 2018) 

  • Large effect estimate
    • Standardized response mean = 2.65
    • Effect size = 2.13

 

Stroke

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Standard Error of Measurement (SEM)

Chronic Stroke: (Hsieh et al, 2007; n = 56; mean time post-stroke = 1197.1 (1281.8) days; mean age = 59.4 (14.6) years; Taiwanese sample)

  • SEM = 1.45 points

Stroke: (Ghandehari, et al., 2012; n=25; female=44%; mean age 65.5; time between stroke and assessment=7 days; ischemic stroke n=68%; hemorrhagic stroke n=22%; Iranian sample)

  • SEM for entire group (n = 25): 2.466 

Minimal Detectable Change (MDC)

Chronic Stroke: (Hsieh et al, 2007)

  • MDC = 4.02 points

Stroke: (Ghandehari, et al., 2012; calculated from SEM = 2.466) 

  • MDC for entire group (n = 25): 6.84

Minimally Clinically Important Difference (MCID)

Acute Stroke: (Hsieh et al, 2007; n = 43; mean age = 55.4 (14.6) years; mean time since stroke 7.04 (64.1) days; Taiwanese sample)

  • MCID (95% CI) (Anchor-based method) = 1.85 (0.89-2.81) points
  • MCID (95% CI) (Distribution-based method) = 1.45 (1.22-1.78) points

Cut-Off Scores

Acute Stroke: (Uyttenboogaar et al, 2005; n = 1034; mean age = 69.1 (12.8) years; Median BI score = 80 (IQR = 40 to 100); assessed 12 weeks post stroke)

  • Cutoff scores that indicate a favorable outcome:
    • > 95 (sensitivity 85.6%; specificity 91.7%)
    • > 90 (sensitivity 90.7%; specificity 88.1%)
    • > 75 (sensitivity 95.7%; specificity, 88.5%)
 

Stroke: (Bernat et al., 2015; n=106; female=45.3%; median age=69, median time between stroke and assessment=82 days)

  • Scores <62.90 indicate moderate disability
  • Scores <21.30 indicate severe disability

Ischemic Hemispheric Stroke: (Kwakkel, et al., 2011; n = 206; mean age = 66.3 (14.0), Dutch translation):

Cutoff scores of this study were: “The optimal cutoff value, with the highest sensitivity and 1-specificity, was found when BI was dichotomized into <=6 points (ie, severe disability) and >=7 points (ie, moderate to mild disability)”

Sensitivity:

                        Day 2 post-stroke: .829 (95% CI,.768-.879)

                        Day 5 post-stroke: .810 (95% CI,.760-.852)

                        Day 9 post-stroke: .777 (95% CI, .733-.813)

Specificity:

                       Day 2 post-stroke: .624 (95% CI,.560-.677)

                        Day 5 post-stroke: .713 (95% CI,.634-.775)

                        Day 9 post-stroke: .742 (95% CI,.650-.819)

 

 

Normative Data

Acute Stroke: (Hsueh et al, 2002; n = 118, mean age = 67.5 (10.9) years; mean number of days in rehab = 26; Taiwanese sample)

Normative Data:

 

BI

 

BI-5  (Modified version)

 
 

Admission

Discharge

Admission

Discharge

Median

5

10

1

4

Inter-quartile range

1.5 - 8

6 - 13

0 - 1

1 - 5

Chronic Stroke: (Lin et al, 2010; n = 45, mean age = 60.0 (12.6) years; mean time since stroke = 9 months; outpatient therapy by a trained physiotherapist at 1 week, 2 months, and 5 months of out patient rehab; Taiwanese sample)

Normative Data:

 

1 week

2 months

5 months

Median score

18

19

19

1st to 3rd quartile

16 - 20

17 - 20

17 - 20

Chronic Stroke: (Lin et al, 2009)

Assessment of upper extremity function after stroke

 

14 days

30 days

90 days

180 days

Mean Age

64.3

63.9

64.0

64.0

BI Score

9.1

13.8

16.8

16.6

Ischemic Stroke: (Galeoto, et al., 2019; n = 99; Mean age = 73.82 (11.93); Mean time from ischemic stroke event to first administration = 3 days (1 day), Italian culturally adapted version)

  • Mean administration time=5 minutes (SD=2.5)

 

Stroke: (Ghandehari, et al., 2012)

  • Median BI score 57.52 (SD: 27.567)

 

Ischemic Hemispheric Stroke: (Kwakkel, et al., 2011):

  • Median BI at 2.18 (1.19) days post-stroke: 7 points (IQ 3 to 12)
  • Median BI at 6 months post-stroke: 19 points (IQ 16.75-20). 60.7% showed full independence

Test/Retest Reliability

Stroke: (Green et al., 2001; n=22; males=16; mean age=71.6(6.8); mean time from stroke to admission to the study=15 months)

  • Mean difference (between first and second assessment)=0.4 (95% CI .0.01 - .90)
  • Reliability coefficient=2 (out of 20)
  • Percentage agreement >75%

 

 

Interrater/Intrarater Reliability

Acute Stroke: (Hsueh et al, 2001; n = 121; assessed at 14, 30, 90 and 180 days)

  • Adequate to Excellent item level agreement among raters (kappa value range, 0.53-0.94)
  • Excellent total score agreement (ICC = 0.94)

All Stroke Survivors: (Duffy et al. 2013; n = 543)

  • Good to Excellent Interrater Reliability: (k = .62-.99)
  • “Meta-analysis suggested overall very good reliability for standard face-to-face BI (κw, 0.95; 95% CI, 0.94–0.96 fixed effects modeling; κw, 0.93; 95% CI, 0.90–0.96 random effects modeling); there were insufficient suitable data to perform meta-analysis for other methods of BI assessment”

 

Ischemic Stroke: (Galeoto, et al., 2019)

  • Intrarater reliability: Excellent - ICC = .987 (95% CI .975 - .993); Cohen’s Kappa = .69
  • Interrater reliability: Excellent - ICC = .909 (95% CI .852-.948); Light’s Kappa = .79

 

Stroke: (Ghandehari, et al., 2012)

  • Interrater variability was not significant (df = 4; F = 1.061; 95% confidence interval = 52.639-62.400; P = 0.379).

 

Internal Consistency

Acute stroke: (Hsueh et al, 2001)

  • Excellent internal consistency (alpha = 0.89 to 0.90)

Acute Stroke: (Hsueh et al, 2002)

Barthel Index:

  • Excellent internal consistency at admission (alpha = 0.84)
  • Excellent internal consistency at discharge (alpha = 0.85)

BI-5 (a modified 5-item version):

  • Adequate internal consistency at admission (alpha = 0.71)
  • Adequate internal consistency at discharge (alpha = 0.73)

Ischemic Stroke: (Galeoto, et al., 2019):

  • Excellent: Cronbach’s Alpha= .901* (p<.001)

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Hsueh et al, 2002)

  • Excellent correlation between the FIM motor and 10 item BI at both admission and discharge (r > 0.92)
  • Excellent agreement between the FIM motor and 10 item BI at both admission and discharge (ICC >0.83)

Acute Stroke: (Wade and Hewer, 1987; n = 976; age not reported; assessed within 7 days of onset)

  • Excellent concurrent validity Between the modified BI and measure of motor ability using the Motricity Index (r = 0.73 to 0.77)

Ischemic Hemispheric Stroke: (Kwakkel, et al., 2011)

  • Positive predictive value

                         Post-Stroke Day 2: Excellent - .696 (95% CI, .645-.739)

                         Post-Stroke Day 5:  Excellent -.816 (95% CI, .766-.859)

                         Post-Stroke Day 9:  Excellent -.864 (95% CI, .815-.905)

  • Negative predictive value

                          Post-Stroke Day 2: Excellent- .778 (95% CI, .699-.844)

                          Post-Stroke Day 5: Excellent- .704 (95% CI, .626-.769)

                          Post-Stroke Day 9: Excellent- .613 (95% CI, .536-.676)

  • Odds Ratio:
    • Post-Stroke Day 2: 8.013 (95% CI, 4.192-15.316)
    • Post-Stroke Day 5: 10.533 (95% CI, 5.458-20.325)
    • Post-Stroke Day 9: 10.042 (95% CI, 5.082-29.842)
    • *Used a cutoff of 7 points on the BI
  • Overall accuracy for correctly predicting outcome increased from 72.8% on day 2 to 77.2% on day 5, down to 76.6% on day 9 post-stroke

 

Floor/Ceiling Effects

Acute Stroke: (Duncan et al, 1997; n = 304; mean age = 62.89 (13.17) years; time since stroke not specified)

  • BI not sensitive to change among mild stroke/transient ischemic attack patients scoring at least 100 points.

Acute Stroke: (Hsueh et al., 2002)

Barthel Index (BI)

  • Excellent: No ceiling effects at admission or discharge
  • Adequate floor effects at admission (18.2%) and discharge (4.7%)

5-Item Short Form BI (BI-5)

  • Excellent: No ceiling effects at admission or discharge
  • Poor floor effect at admission (46.6%)
  • Adequate floor effect at discharge (13.6%)

Mild Stroke:  (Duncan et al, 1997)

  • The Barthel Index, which has a ceiling effect and which captures only physical domains of health status, is not adequate for assessing the full impact of stroke-related disability

Responsiveness

Acute Stroke: (Hsueh et al, 2002):
Responsiveness (Standardised Response Mean)

  • The B1 and BI-5 are highly responsive in detecting changes:
  • BI (Original Measure) = 1.2
  • Bi-5 (Modified version) = 1.2

Acute Stroke: (Salbach et al, 2001; n = 53; mean age = 68 (13) years)

  • The 5MWT (at a comfortable pace) at 5 weeks post-stroke was more responsive than the Berg Balance Scale or the Barthel Index
  • All three measures were found to be responsive to change

Acute Stroke: (Tilling et all, 2001)

Acute Stroke: (Duncan et al, 1997; n = 304; mean age = 62.89 (13.17) years; time since stroke not specified):

  • BI not sensitive to change among mild stroke/transient ischemic attack patients scoring at least 100 points (maximal score is 100 points).
  • “Patients who score 100 on the Barthel Index have widely varying scores on the physical function subscale of the MOS-36; for example, fewer than 20% scored the maximum possible value on this subscale. Thus, if the Barthel Index is the only stroke outcome measure used, a decline in many domains of health status will be missed. The Barthel Index will also be ineffective in detecting the psychosocial dimensions of impaired function.”

Ischemic Hemispheric Stroke: (Kwakkel, et al., 2011)

  • Day 2 Post-Stroke: Adequate AUC = 0.785 (SE = 0.035; p < 0.001; 95% CI, 0.715-0.854)
  • Day 5 Post-Stroke: Adequate AUC = 0.837 (SE = 0.031; p < 0.001; 95% CI, 0.776-0.899)
  • Day 9 Post-Stroke: Adequate AUC = 0.848 (SE = 0.030; p < 0.001; 95% CI, 0.788- 0.908).
  • Significant difference between AUC on Day 2 and Day 5 (z = 3.537, P < 0.001) and between Day 2 and 9 (z = 3.621, p < 0.001). No significant difference was found between the AUC of the ROC curves of Days 5 and 9 (z = 1.416, p = 0.08).

 

Neurologic Conditions

back to Populations

Standard Error of Measurement (SEM)

Parkinson’s Disease: (Taghizadeh, et al., 2019; n = 260, mean age = 60.3 (12.3) years; female=28.1%; Mean time since diagnosis (SD): 6.6 (5.5); Stage 1: 33.9%; Stage 2: 36.5%; Stage 3: 20%; Stage 4: 9.6%, Iranian version) 

  • SEM ON medication (1 hour after levodopa) for all (n=260): 3.41
  • SEM OFF medication (12 hours after last evening dose) (n=260): 9.90

Normative Data

Parkinson’s Disease: (Taghizadeh, et al., 2019): 

  • ON Medication Mean BI (SD) =94.0(12.6)
  • OFF Medication Mean BI (SD) =80.0(23.3)

Test/Retest Reliability

Parkinson’s Disease: (Taghizadeh, et al., 2019): 

  • ON Medication Phase (n=260): ICC (95% CI): .84 (.78-.91)
  • OFF Medication Phase (n=260): ICC (95% CI): .77 (.65-.85)

Interrater/Intrarater Reliability

Parkinson’s Disease: (Taghizadeh, et al., 2019): 

  • Inter-rater Reliability
    • Excellent Reliability: ON Medication Phase (n=260): ICC (95% CI): .91 (.87-.94)
    • Excellent Reliability: OFF Medication Phase (n=260): ICC (95% CI): .90 (.86-.93)

Internal Consistency

Parkinson’s Disease: (Taghizadeh, et al., 2019): 

  • ON Medication - Excellent: Cronbach’s alpha = 0.85
  • OFF Medication - Excellent: Cronbach’s alpha = 0.88

Construct Validity

Convergent validity:

Parkinson’s Disease: (Taghizadeh, et al., 2019) 

  • Adequate to Excellent correlations between total score on the Barthel Index and other scales in both the “ON” and “OFF” medication phases

Correlations Between Total Score on Barthel Index and Other Scales While On or Off Medication

Scale:

SE

UPDRS-ADL

PDQ-39 (ADL)

BBS

mRS

ON Medication

0.63

-0.53

-0.51

0.55

-0.68

OFF Medication

0.71

-0.72

-0.74

0.71

-0.74

SE: Schwab & England ADL Scale; UPDRS-ADL: Unified Parkinson Disease Rating Scale-Activities of Daily Living; PDQ-39 (ADL): Parkinson’s Disease Questionnaire-39 (Activities of Daily Living); BBS: Berg Balance Scale; mRS: modified Rankin Scale

 

Discriminant validity:

Parkinson’s Disease: (Taghizadeh, et al., 2019)

  • Significant difference between the total mean scores on the BI for the "ON" and "OFF" medication phases (ON: 94.0 (12.6), OFF: 80.0 (23.3); Wilcoxon test: Z = -7.64, p < 0.0001)
 
 

Face Validity

Parkinson’s Disease: (Taghizadeh, et al., 2019): 

  • Floor Effect
    • Excellent: ON Medication Phase (n=260): 0%
    • Excellent: OFF Medication Phase (n=260): 0%
  • Ceiling Effect
    • Poor: ON Medication Phase (n=260): 47.7%
    • Poor: OFF Medication Phase (n=260): 32.7%

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