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The Barthel Index (BI) is a 10-item scale that measures a patient’s functional independence in basic activities of daily living and mobility, scored from 0 to 100. This page covers the 10 items, the standard scoring and score bands, the Modified Barthel Index, and how it differs from the licensed Functional Independence Measure. For related instruments used in the same discharge-planning and rehabilitation-tracking workflow, see CASRAI’s inpatient rehabilitation facility guide and the NIH Stroke Scale page, since the BI is most heavily used in stroke and neurological rehabilitation.
What the Barthel Index is, and who built it
The Barthel Index was developed by Dorothea Barthel and Florence Mahoney and published in 1965 (Mahoney FI, Barthel DW, “Functional evaluation: the Barthel Index,” Maryland State Medical Journal), originally to track the progress of patients with neuromuscular and musculoskeletal conditions through a rehabilitation program. It remains one of the most widely used and cited functional-status instruments in stroke rehabilitation specifically, and unlike the FIM, it is not a proprietary licensed instrument — it can be used and reproduced without a licensing fee, which is part of why it appears so widely in published research and clinical protocols worldwide.
The 10 items and scoring
Each item is scored in increments of 0, 5, or 10 (a few items are scored only 0/10), based on how much assistance the patient needs. Higher points mean more independence.
| Item | What it assesses |
|---|---|
| Feeding | Getting food from a plate/tray into the mouth |
| Bathing | Washing the whole body |
| Grooming | Washing face, combing hair, shaving, brushing teeth |
| Dressing | Putting on and removing clothing, fastenings, and shoes |
| Bowel control | Continence over the preceding period |
| Bladder control | Continence over the preceding period |
| Toilet use | Getting on/off the toilet, managing clothing, wiping |
| Transfers | Moving between bed and chair, including sitting up |
| Mobility | Walking on a level surface, or self-propelling a wheelchair if unable to walk |
| Stairs | Ascending and descending a flight of stairs |
Interpreting the total score
Total scores range from 0 to 100. The commonly published interpretation bands are:
- 0–20: total dependency
- 21–60: severe dependency
- 61–90: moderate dependency
- 91–99: slight dependency
- 100: complete independence in the 10 assessed activities
A score of 100 means independence in these specific tasks, not the absence of any disability — it does not capture cognition, instrumental activities like managing finances or medications, or a patient’s ability to actually live alone safely. As with any functional-status instrument, confirm the specific scoring convention (some settings use a 0/5/10 system, others a modified 0–20-per-item weighting) your organization has adopted before comparing scores across units or facilities.
The Modified Barthel Index
Several modified versions of the original Barthel Index exist, generally adding finer point gradations (typically 5-point increments per item instead of the original’s coarser 0/5/10 steps) to reduce the ceiling effect and make the scale more sensitive to smaller functional changes during a rehabilitation stay. Because more than one “modified” scoring convention circulates in practice, a chart or research protocol citing the Modified Barthel Index should specify exactly which version and point scheme it used — the label alone doesn’t guarantee comparability across studies or facilities.
Reliability and what it misses
The BI is reported to have good reliability and validity across many studies and translations, and it administers quickly (commonly 2–10 minutes) via direct observation, interview, or a review of the preceding 24–48 hours of documented performance. Its main limitations are a ceiling effect (it doesn’t distinguish well among high-functioning patients who are already close to independent) and a narrow scope: it assesses only physical, basic self-care activities and does not evaluate cognition, mood, or instrumental activities of daily living such as cooking, managing money, or using transportation.
Barthel Index vs. the Functional Independence Measure
The BI and the FIM are frequently compared because both are widely used to track functional status in rehabilitation, but they differ in scope and access. The FIM adds a 5-item cognitive subscale (communication and social cognition) that the BI does not assess, and uses a finer 7-point-per-item scale that is generally considered more sensitive to incremental change. The BI, in exchange, is free to use and reproduce, requires no formal certification, and takes less time to complete — the FIM is a proprietary instrument licensed through UDSMR (Uniform Data System for Medical Rehabilitation), and consistent scoring across clinicians typically requires UDSMR-provided training. A program choosing between the two should weigh the FIM’s added cognitive domain and CMS-reporting relevance in inpatient rehabilitation facilities against the BI’s lower cost and administrative burden.
Use in discharge planning and nursing workload
Beyond rehabilitation outcome tracking, the BI is used to help plan a patient’s discharge destination and the level of home or facility support they’ll need, and published research has also used it as a proxy for estimating nursing workload — patients scoring lower on the BI generally require more direct nursing time for basic care tasks. As with any score that feeds a downstream decision (discharge planning, staffing, or a quality metric), the same chart-audit discipline applies as with other functional and risk-assessment scales: confirm the score was completed on the schedule policy requires and that it’s the version actually driving the care or discharge decision documented in the chart, not a stale prior score.
Frequently asked questions
What is a normal Barthel Index score?
A score of 100 indicates complete independence in the 10 assessed basic activities of daily living. Scores of 91–99 indicate only slight dependency, while scores of 90 or below indicate progressively greater dependency.
How do you interpret a Barthel Index score?
Sum the 10 item scores (0–100 total, scored in 0/5/10-point increments per item). The commonly published bands are 0–20 (total dependency), 21–60 (severe), 61–90 (moderate), 91–99 (slight), and 100 (complete independence).
What is the difference between the Barthel Index and the Modified Barthel Index?
The Modified Barthel Index generally uses finer, 5-point-per-item scoring gradations than the original’s coarser 0/5/10 steps, intended to reduce the ceiling effect and better detect small functional changes. Because multiple “modified” versions circulate, a chart or study using the term should specify exactly which scoring scheme it applies.
Barthel Index vs. FIM: which should we use?
The FIM adds a cognitive subscale and finer per-item scoring the Barthel Index lacks, and is the instrument CMS has historically used in inpatient rehabilitation facility quality reporting, but it is a licensed instrument requiring UDSMR training. The Barthel Index is free, faster to administer, and sufficient when only basic physical ADL tracking is needed.
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