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Barthel Index of Activities of Daily Living

The Barthel Index scores independence in 10 activities of daily living from 0 (totally dependent) to 100 (independent): feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility and stairs. Common bands: 0–20 total, 21–60 severe, 61–90 moderate, 91–99 slight dependence, 100 independent.

  • Feeding: Unable (0); Needs help cutting, spreading butter, etc. (5); Independent (10)
  • Bathing: Dependent (0); Independent (or in shower) (5)
  • Grooming: Needs help with personal care (0); Independent face/hair/teeth/shaving (5)
  • Dressing: Dependent (0); Needs help but can do about half unaided (5); Independent (including buttons, zips, laces) (10)
  • Bowels: Incontinent (or needs enemas) (0); Occasional accident (5); Continent (10)
  • Bladder: Incontinent, or catheterised and unable to manage alone (0); Occasional accident (5); Continent (10)
  • Toilet use: Dependent (0); Needs some help but can do something alone (5); Independent (on and off, dressing, wiping) (10)
  • Transfers (bed to chair and back): Unable, no sitting balance (0); Major help (one or two people, physical), can sit (5); Minor help (verbal or physical) (10); Independent (15)
  • Mobility on level surfaces: Immobile or <50 yards (0); Wheelchair independent, including corners, >50 yards (5); Walks with help of one person (verbal or physical) >50 yards (10); Independent (may use any aid, e.g. stick) >50 yards (15)
  • Stairs: Unable (0); Needs help (verbal, physical, carrying aid) (5); Independent (10)
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Interpretation

ResultMeaning
0–20Total dependency
21–60Severe dependency
61–90Moderate dependency
91–99Slight dependency
100Independent

Formula

Feeding 0/5/10 · Bathing 0/5 · Grooming 0/5 · Dressing 0/5/10 · Bowels 0/5/10 · Bladder 0/5/10 · Toilet use 0/5/10 · Transfers 0/5/10/15 · Mobility 0/5/10/15 · Stairs 0/5/10. Total 0–100.

Clinical pearls

  • Score what the patient actually does (usually over the last 24–48 h), not what they could do; needing supervision means not independent.
  • The dependency bands are from Shah et al. 1989 and are conventions, not validated care thresholds. Some services use the 0–20 version (Collin & Wade), which is this score ÷ 5.
  • Strong ceiling effect: a score of 100 does not mean the person can live alone (it does not cover cooking, cognition or safety).

Examples

barthel feeds independently, needs help dressing, continent, walks with help of one, needs help on stairs, transfers with minor help, independent toileting, bathing dependent, grooming independentBarthel index: all independentadl score bedbound, tube fed, incontinent of urine and stool, dependent for everything

FAQ

What is a good Barthel Index score?

100 means independent in all 10 basic ADLs. 91–99 is slight dependency, 61–90 moderate, 21–60 severe and 0–20 total dependency.

How is the Barthel Index used after stroke?

It tracks recovery of basic self-care; scores ≥95 (or ≥60 for "functional independence" in some trials) are common outcome thresholds.

Evidence

  1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965;14:61–5.
  2. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989;42:703–9.

Neurology · Reviewed 2026-10-14 · Methodology