What the Barthel Index measures
The Barthel Index was published by Mahoney and Barthel in 1965 to measure independence in people having rehabilitation, originally after stroke. It is still one of the most widely used measures of basic self care and mobility in hospitals, rehabilitation units and aged care.
It covers 10 activities:
- Feeding
- Bathing
- Grooming, such as washing your face, brushing teeth and shaving
- Dressing
- Bowel control
- Bladder control
- Toileting
- Transfers between bed and chair
- Walking on a level surface, or using a wheelchair
- Climbing stairs
How scoring works
In the most common version, each activity is scored by how much help is needed, in steps of 5 points. Some items, such as transfers and walking, can score up to 15. Others, such as grooming and bathing, only score 0 or 5. The total runs from 0, meaning fully dependent, to 100, meaning independent in all 10 activities.
A shorter version scores the same items from 0 to 20, and modified versions with more detailed scoring are also used. When you read a report, check which version was used before comparing scores.
Who completes it and how
Nurses, physiotherapists, occupational therapists and doctors use the Barthel Index. It can be completed by watching the person do the tasks, or by asking the person or someone who knows them well. Asking takes only a few minutes, while observation can take up to about 20 minutes.
It records what the person actually does, not what they might be able to do on a good day. So it is worth telling the assessor about the help you really get, including prompting and supervision.
Limits of the Barthel Index
- It only covers basic self care and mobility, not cooking, shopping, money, work or community life
- It does not measure thinking, memory, communication or behaviour, which are often the biggest support needs
- Ceiling effects: many people score 100 yet still need a lot of support in daily life
- It gives a snapshot. Fluctuating conditions can look very different from one day to the next
The Barthel Index and the NDIS
The NDIA does not require a Barthel score. It asks for evidence of how your disability affects your functional capacity, ideally from treating professionals, and for some disabilities it names other preferred tools, such as WHODAS 2.0.
A Barthel score from a hospital or rehabilitation discharge summary can still be useful supporting evidence, especially a low score, because it shows clearly how much help you needed with basic tasks. Because of its limits, it works best alongside a functional capacity assessment that covers the rest of your life.
For providers and therapists
If you include a Barthel score in an NDIS report, say which version you used, how it was collected and when. Pair it with tools that capture cognition, communication and community participation, and explain in plain words what the score means for the hours and type of support the person needs.