The Barthel index, an indicator of autonomy

By Cristiano Antonino On Mar 9, 2022

The Barthel index, functional for the measurement of patient autonomy, is a universally recognised instrument and considered one of the most reliable for the evaluation of autonomy in daily activities

Among the measurement scales used in the nursing profession, the Barthel index is a universally accepted reference for the evaluation of physical function and autonomy of patients in daily activities.

Its widespread use makes it possible to standardise the interprofessional language between operators and to facilitate the sharing of objectives for the recovery of patient self-sufficiency within the work team

The Barthel index can be used on patients with neurological injuries, strokes, balance disorders, ataxia, paraplegia, etc

The scale is administered to the patient by nurses both on admission to and discharge from hospital and also allows the level of performance of the rehabilitation facility to be assessed.

The index analyses ten variables describing activities of daily living (e.g. the ability to eat, dress, manage personal hygiene, wash oneself and others) and mobility (moving from chair to bed, walking on level ground, climbing and descending stairs).

Each item is assigned a score that varies according to the item itself and the patient’s degree of functionality: full, reduced or absent.

A higher total score corresponds to a higher probability of being able to live independently at home after discharge from hospital or a long-term care ward.

The resulting score expresses the degree of assistance the patient’s condition requires in daily activities.

A value of zero indicates a totally dependent patient, while a value of 100, which is the maximum, indicates a fully independent patient.

The assessment forms the basis for discussion by the working team, which is responsible for designing the rehabilitation programme.

The team includes doctors, nurses, physiotherapists and speech therapists.

In order to correctly complete the Barthel index, certain guidelines must be taken into account:

It is necessary to record what a patient actually does and NOT what he/she could do.
The main purpose is to establish the degree of independence from any physical or verbal help.
The need for supervision does NOT make the patient dependent.
The patient’s performance should be established using the best available sources such as: direct questions to friends/relatives/nurses but also by direct observation if possible.
It is important to assess performance over the previous 24-48 hours.
An intermediate score in one category implies that the patient participates in more than 50% of the effort.
The use of functional aids to achieve autonomy is allowed.

Strengths:

simple and quick to administer;
allows follow-up telephone interviews.

Weaknesses

limited scope of assessment (the scale measures only basic functions and does not include other domains such as cognitive);
insensitive to small changes.

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