Barthel index: what it is, how it is used and what it evaluates

Let's think for a moment about what the vast majority of people do every day from the moment they wake up. We get up, we shower and clean up, we get dressed, we have breakfast, we go to work/study, we eat... They are apparently simple activities that we have automated and that we do not usually stop to think about.

But these are basic activities that we all have to do simply to maintain ourselves healthy and have a certain autonomy, and that we have been learning and developing throughout life.

Now, in some cases (accidents, dementia and other neurological diseases, disability...) a person may lose the ability to do them for themselves or that it does not develop them. Taking into account that these are basic skills, this implies that in order to achieve adaptive daily functioning the subject will need help to be able to carry them out: he will have a certain level of dependency, whether temporarily or permanent.

Assessing when a person is dependent and the degree to which he needs specific help is not as simple as it may seem. at first glance, but fortunately there are different evaluation instruments that allow us to carry out this assessment.

One of them is the Barthel scale or Index., which we are going to talk about throughout this article.

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The Barthel Index

An evaluation instrument in the form of a scale is known as the Barthel Index or Barthel Scale, which is sometimes also called the Maryland Disability Index. widely used by various professionals in the socio-health branch in order to evaluate or assess the level of independence that a person has when carrying out activities basic.

This measure allows assessing the existence of a physical or neurological disability that represents a difficulty for the performance and completion of fundamental tasks in our daily lives.

Specifically, this index values ​​the so-called basic activities of daily living, which are understood as the set of actions and activities that a person needs to do in order to maintain adequate self-care and stay healthy and active. That is, unlike other activities that are linked more to the subject's relationship with the environment that surrounds him, the basic ones focus on how the subject maintains himself.

Not being able to carry out these activities is clearly detrimental to the physical and mental integrity of the subject and could even lead to death if not helped.

The application of the Barthel index, which began to be used in hospitals from 1955, was seeks to evaluate how the performance is in a total of ten of said basic activities in such a way that It is observed whether the individual can perform them without any problem, needs help punctually or is totally dependent on external help.

Its total score (whose maximum is 100 and minimum 0) gives us a general idea of ​​the need for external support, although each of the items available can give us relevant information about what areas or types of activities there are problems or if a specific type of support can be provided or other.

It must be taken into account that this index must be passed at the initial moment in order to assess whether or not the subject presents problems in his daily life, but also during and after any rehabilitative intervention that is carried out. use. This will allow us to see whether or not said intervention has been successful and to what level, as well as adjust the type and level of help provided to the patient's needs. It is also important to keep in mind that what the subject does is evaluated, not what he could do.

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Basic activities that evaluate

The Barthel Index or Scale evaluates, as we have said, a total of ten basic activities of life. daily, which can be divided mainly into feeding, hygiene, movement and control of sphincters. The specific activities that are observed are the following.

1. Meal

This item assesses whether the subject is able to eat on his or her own. It involves being able to put food in the mouth, chew and swallow. In addition to this, it is also assessed whether the person is able to perform actions such as cutting food or pouring water, although if, despite not being able to do these last actions, they can eating independently will also have a non-zero score (10 if he can do everything independently, 5 if he needs help cutting, using cutlery, etc.). If you need complete help to eat, the score is 0.

It is important to keep in mind that what is valued is the act of eating itself: it does not matter for this assessment whether the person has cooked the food or another person has prepared and served it.

2. Washing/Grooming

This activity implies being able to maintain body hygiene on one's own, so that one can shower and clean oneself autonomously.

Whether you can get in and out of the bathroom is also taken into account. It is assessed whether he needs help or supervision (0) or if he can do it independently (10)..

3. Get dressed

Another basic activity is dressing. Here it is assessed whether the subject can put on and take off clothes autonomously and without help (10 points), they must be helped in some moments but most things you can do yourself (5 points) or you need someone to help you at all times (0 points).

3. To get ready

This activity partly involves personal hygiene, and includes actions such as combing hair, washing face or hands, shaving or putting on makeup. It is assessed whether the subject can do it by himself (10) or needs help to do it (0).

4. Fecal continence/incontinence

On this occasion we are talking about a basic activity in which the subject eliminates digestion waste through the fecal route. It is assessed whether the subject is able to contain feces (10 points), whether he has any occasional episodes of incontinence or needs helps from time to time (5) or if he is unable to control his sphincters on his own, being incontinent on a regular basis (0).

This evaluation is carried out taking into account the action carried out during the week prior to the assessment.

5. Continence/urinary incontinence

In the same way that fecal incontinence is evaluated, urinary incontinence is also evaluated.

In this sense, also taking into account the performance in the week prior to the evaluation, it will be observed whether the subject can hold urine and/or take care of the functioning of a possible catheter (10 points), if you have episodes (maximum 1 daily) of incontinence (5) or if you cannot regularly hold urine (0 points).

6. Use of the toilet

Linked to the two previous points, in this case it is valued whether the subject is able to use the toilets themselves. If you can go to the toilet, take off your clothes, relieve yourself and clean yourself, it is valued at 15 points.

If you need help but are able to clean yourself, 5 points are valued and if you need help for both aspects, the item will be valued 0 points.

7. Transfer to chair or bed

This activity would be one of those that assesses the subject's ability to move, specifically whether he is able to sit or stand up on his own or get in and out of bed.

The subject may be totally independent (15 points), need little help (10 points), need someone specialized and with great strength (something that implies that much of the effort is made thanks to said help) helps him although he can remain seated by himself (5 points) or need total help in which either a crane or several people move him and he cannot sit (0 points).

8. Wander

Another of the basic activities that are evaluated in the Barthel Index or Scale is the ability to ambulate and move over short distances. It is assessed whether the subject is able to walk 50 meters without the help of another person or walkers (although they can use crutches or canes). If they are able to independently, they are scored 15 points, if they require some help or walker, 10, and if they depend on help to move, they are scored 0.

In the case of people in a wheelchair who can move independently with said chair, they are scored with 5 points.

10. Use stairs

In a large part of our urbanizations and houses we can find stairs, steps and changes in height, of so that being able to use them is considered a basic activity of daily life when it comes to commute.

A subject who can go up or down stairs autonomously is scored with 10 points in this item, if needs someone to help or supervise them 5 and if they are not able to use the stairs the item is scored 0 points.

Punctuation and significance

The Barthel Index or Scale is easy to apply and score. Mainly, it must be taken into account that the maximum score is 100 (90 in the case of those who use a wheelchair) and that each item can be scored with 0, 5 or 10 points. Ten points are awarded when the subject is totally independent for the action referred to in the item, five when he or she needs help. for specific aspects or when he occasionally has difficulties and zero points are given when the subject is dependent on said activity.

Likewise, it must be taken into account that some items such as washing or grooming only consist of scores of 5 (independent) or 0 (dependent), and in the In cases of moving or wandering, a score of 15 is added to reflect that the subject can move without help (10 would imply minimal or supervision).

The score obtained from this scale allows us to obtain an idea of ​​the degree of dependence of the subject evaluated.

Scores of 100 imply total independence, and lower scores would reflect increasing dependence for activities of daily living. Scores between 100 and 60 indicate the existence of a slight dependency or need for help, between 55 and 40 a moderate dependency, from 35 to 20 would indicate serious dependence and scores lower than 20 points would indicate that the subject has a dependence. total.

Bibliographic references:

• Cid-Ruzafa, J. and Damián-Moreno, J. (1997). Assessment of physical disability: the Barthel index. Spanish Journal of Public Health, 71 (2). Madrid Spain.
• Barrero Solís, C.L., García Arrioja, S. and Ojeda Manzano, A. (2005). Barthel Index (BI): An essential instrument for functional evaluation and rehabilitation. Plasticity and Neurological Restoration, 4 (1-2). International Association for Brain Plasticity, A.C.