Modified Berthel Index (Shah Version) - Self Care Assessment Form

What Is the Barthel Index Used for?

The Barthel index scale is a simple and convenient tool used to evaluate self-care abilities and everyday activities of an individual. First presented in 1965, the Barthel index was evaluated using a score of 0 to 100 and replaced the old 20-score system as less accurate and effective. This 100-score evaluation system still remains in use.

The printable assessment form available below is a handy four-page template that consists of a table for self-care assessment and two tables for interpretation of the obtained results. The evaluation table is divided into eleven categories: chair/bed transfers, ambulation, ambulation/wheelchair, stair climbing, toilet transfers, bowel control, bladder control, bathing, dressing, personal hygiene, and feeding. Each category contains explanations regarding the evaluation of the patient's performance and the number of points to assign in each case. The number of points is based on the amount of time and assistance the patient needs in order to accomplish a specific everyday task.

Sufficient explanations provided on every page of the form make the spreadsheet comprehensive and easy to use. The assessment takes about 5 to 10 minutes and does not require any special training or equipment. Basically, anyone who knows the patient well can perform this test. Patients can do a self-evaluation, however, self-evaluation is not recommended for patients 75 and older.

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Appendix 3
MODIFIED BARTHEL INDEX (SHAH VERSION) : SELF CARE ASSESSMENT
INDEX ITEM
SCORE
DESCRIPTION
0
Unable to participate in a transfer. Two attendants are required to transfer the
patient with or without a mechanical device.
3
Able to participate but maximum assistance of one other person is require in all
aspects of the transfer.
8
The transfer requires the assistance of one other person. Assistance may be
required in any aspect of the transfer.
CHAIR/BED TRANSFERS
12
The presence of another person is required either as a confidence measure, or to
provide supervision for safety.
15
The patient can safely approach the bed walking or in a
wheelchair, lock brakes, lift footrests, or position walking aid, move safely to bed,
lie down, come to a sitting position on the side of the bed, change the position of
the wheelchair, transfer back into it safely and/or grasp aid and stand. The patient
must be independent in all phases of this activity.
0
Dependent in ambulation.
3
Constant presence of one or more assistant is required during ambulation.
Assistance is required with reaching aids and/or their manipulation. One person is
8
required to offer assistance.
The patient is independent in ambulation but unable to walk 50 metres without
12
help, or supervision is needed for confidence or safety in hazardous situations.
AMBULATION
The patient must be able to wear braces if required, lock and unlock these braces
assume standing position, sit down, and place the necessary aids into position for
15
use. The patient must be able to crutches, canes, or a walkarette, and walk 50
metres without help or supervision.
0
Dependent in wheelchair ambulation.
1
Patient can propel self short distances on flat surface, but assistance is required for
AMBULATION/WHEELCHAIR
all other steps of wheelchair management.
3
Presence of one person is necessary and constant assistance is required to
manipulate chair to table, bed, etc.
* (If unable to walk)
4
The patient can propel self for a reasonable duration over regularly encountered
Only use this item if the
terrain. Minimal assistance may still be required in “tight corners” or to negotiate
a kerb 100mm high.
patient is rated “0” for
Ambulation, and then
only if the patient has
5
To propel wheelchair independently, the patient must be able to go around corners,
been trained in
turn around, manoeuvre the chair to a table, bed, toilet, etc. The patient must be
wheelchair management.
able to push a chair at least 50 metres and negotiate a kerb.
9
Appendix 3
MODIFIED BARTHEL INDEX (SHAH VERSION) : SELF CARE ASSESSMENT
INDEX ITEM
SCORE
DESCRIPTION
0
Unable to participate in a transfer. Two attendants are required to transfer the
patient with or without a mechanical device.
3
Able to participate but maximum assistance of one other person is require in all
aspects of the transfer.
8
The transfer requires the assistance of one other person. Assistance may be
required in any aspect of the transfer.
CHAIR/BED TRANSFERS
12
The presence of another person is required either as a confidence measure, or to
provide supervision for safety.
15
The patient can safely approach the bed walking or in a
wheelchair, lock brakes, lift footrests, or position walking aid, move safely to bed,
lie down, come to a sitting position on the side of the bed, change the position of
the wheelchair, transfer back into it safely and/or grasp aid and stand. The patient
must be independent in all phases of this activity.
0
Dependent in ambulation.
3
Constant presence of one or more assistant is required during ambulation.
Assistance is required with reaching aids and/or their manipulation. One person is
8
required to offer assistance.
The patient is independent in ambulation but unable to walk 50 metres without
12
help, or supervision is needed for confidence or safety in hazardous situations.
AMBULATION
The patient must be able to wear braces if required, lock and unlock these braces
assume standing position, sit down, and place the necessary aids into position for
15
use. The patient must be able to crutches, canes, or a walkarette, and walk 50
metres without help or supervision.
0
Dependent in wheelchair ambulation.
1
Patient can propel self short distances on flat surface, but assistance is required for
AMBULATION/WHEELCHAIR
all other steps of wheelchair management.
3
Presence of one person is necessary and constant assistance is required to
manipulate chair to table, bed, etc.
* (If unable to walk)
4
The patient can propel self for a reasonable duration over regularly encountered
Only use this item if the
terrain. Minimal assistance may still be required in “tight corners” or to negotiate
a kerb 100mm high.
patient is rated “0” for
Ambulation, and then
only if the patient has
5
To propel wheelchair independently, the patient must be able to go around corners,
been trained in
turn around, manoeuvre the chair to a table, bed, toilet, etc. The patient must be
wheelchair management.
able to push a chair at least 50 metres and negotiate a kerb.
9
INDEX ITEM
SCORE
DESCRIPTION
0
The patient is unable to climb stairs.
2
Assistance is required in all aspects of chair climbing, including assistance with
walking aids.
5
The patient is able to ascend/descend but is unable to carry walking aids and needs
supervision and assistance.
STAIR CLIMBING
8
Generally no assistance is required. At times supervision is required for safety due
to morning stiffness, shortness of breath, etc.
10
The patient is able to go up and down a flight of stairs safely without help or
supervision. The patient is able to use hand rails, cane or crutches when needed
and is able to carry these devices as he/she ascends or descends.
0
Fully dependent in toileting.
2
Assistance required in all aspects of toileting.
5
Assistance may be required with management of clothing, transferring, or
washing hands.
TOILET TRANSFERS
8
Supervision may be required for safety with normal toilet. A commode may be
used at night but assistance is required for emptying and cleaning.
10
The patient is able to get on/off the toilet, fasten clothing and use toilet paper
without help. If necessary, the patient may use a bed pan or commode or urinal at
night, but must be able to empty it and clean it.
0
The patient is bowel incontinent.
2
The patient needs help to assume appropriate position, and with bowel movement
facilitatory techniques.
5
The patient can assume appropriate position, but cannot use facilitatory techniques
or clean self without assistance and has frequent accidents. Assistance is required
BOWEL CONTROL
with incontinence aids such as pad, etc.
8
The patient may require supervision with the use of suppository or enema and has
occasional accidents.
10
The patient can control bowels and has no accidents, can use suppository, or take
an enema when necessary.
0
The patient is dependent in bladder management, is incontinent, or has indwelling
catheter.
2
The patient is incontinent but is able to assist with the application of an internal or
external device.
5
The patient is generally dry by day, but not at night and needs some assistance
BLADDER CONTROL
with the devices.
8
The patient is generally dry by day and night, but may have an occasional accident
or need minimal assistance with internal or external devices.
The patient is able to control bladder day and night, and/or is independent with
10
internal or external devices.
10
INDEX ITEM
SCORE
DESCRIPTION
0
Total dependence in bathing self.
1
Assistance is required in all aspects of bathing, but patient is able to make some
contribution.
3
Assistance is required with either transfer to shower/bath or with washing or
drying; including inability to complete a task because of condition or disease, etc.
BATHING
Supervision is required for safety in adjusting the water temperature, or in the
4
transfer.
The patient may use a bathtub, a shower, or take a complete sponge bath. The
5
patient must be able to do all the steps of whichever method is employed without
another person being present.
0
The patient is dependent in all aspects of dressing and is unable to participate in
the activity.
2
The patient is able to participate to some degree, but is dependent in all aspects of
dressing.
DRESSING
5
Assistance is needed in putting on, and/or removing any clothing.
8
Only minimal assistance is required with fastening clothing such as buttons, zips,
bra, shoes, etc.
10
The patient is able to put on, remove, corset, braces, as prescribed.
0
The patient is unable to attend to personal hygiene and is dependent in all aspects.
Assistance is required in all steps of personal hygiene, but patient able to make
1
some contribution.
PERSONAL HYGIENE
Some assistance is required in one or more steps of personal hygiene.
3
(Grooming)
Patient is able to conduct his/her own personal hygiene but requires minimal
4
assistance before and/or after the operation.
The patient can wash his/her hands and face, comb hair, clean teeth and shave. A
5
male patient may use any kind of razor but must insert the blade, or plug in the
razor without help, as well as retrieve it from the drawer or cabinet. A female
patient must apply her own make-up, if used, but need not braid or style her hair.
0
Dependent in all aspects and needs to be fed, nasogastric needs to be administered.
Can manipulate an eating device, usually a spoon, but someone must provide
2
active assistance during the meal.
Able to feed self with supervision. Assistance is required with associated tasks
5
such as putting milk/sugar into tea, salt, pepper, spreading butter, turning a plate or
other “set up” activities.
FEEDING
Independence in feeding with prepared tray, except may need meat cut, milk
8
carton opened or jar lid etc. The presence of another person is not required.
The patient can feed self from a tray or table when someone puts the food within
reach. The patient must put on an assistive device if needed, cut food, and if
10
desired use salt and pepper, spread butter, etc.
11
SCORE
INTERPRETATION
00 - 20
Total Dependence
21 - 60
Severe Dependence
61 - 90
Moderate Dependence
91 - 99
Slight Dependence
- 100
Independence
SCORE
PREDICTION
Less Than 40
Unlikely to go home
- Dependent in Mobility
- Dependent in Self Care
60
Pivotal score where patients move from dependency to assisted independence.
60 - 80
If living alone will probably need a number of community services to cope.
More Than 85
Likely to be discharged to community living
- Independent in transfers and able to walk or use wheelchair independently.
REFERENCES
1.
Shah, S., Vanclay, F., & Cooper, B. (1989a). Improving the sensitivity of the Barthel Index for stroke
rehabilitation. Journal of Clinical Epidemiology, 42, 703 - 709.
2.
Shah, S., & Cooper, B. (1991). Documentation for measuring stroke rehabilitation outcomes.
Australian Medical Records Journal, 21, 88 - 95.
3.
Shah, S., Cooper, B., & Maas, F. (1992). The Barthel Index and A D L evaluation in stroke
rehabilitation in Australia, Japan, the U K and the U S A. Australian Occupational Therapy Journal,
39, 5 - 13.
4.
Granger, V., Dewis, L., Peters, W., Sherwood, C., & Barrett, J. (1979). Stroke rehabilitation
analysis of repeated Barthel Index measures. Archives of Physical and Medical
Rehabilitation, 60, 14 - 17.
5.
Hasselkus, B., (1982). Barthel self-care index and geriatric home care patients. Physical and
Occupational Therapy in Geriatrics, 1, 11 - 22.
6.
Leonard, R., & McGovern, L. (1992). The Barthel Index in an acute geriatric setting.
American Journal of Occupational Therapy, 39, 41 - 43.
12

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What Does the Modified Barthel Index Measure?

The Barthel Index of Activities of Daily Living measures the level of the individual's ability to perform activities required for normal everyday life. The Barthel index self-care assessment is used by many as a precise and reliable instrument to check whether the patient is able to take care of their basic needs.

Oftentimes, the document is used to evaluate the condition of a patient recovering after the stroke, or it may be a patient suffering from musculoskeletal or neuromuscular disorders. It is widely employed among oncology patients and elderly individuals. The results of the measurement show whether the patient can be discharged from the hospital to continue their recovery at home.

In general, the modified index is applied to define what activities of daily living patients can perform by themselves and areas they need help with. The Barthel index score interpretation helps to determine the patient's degree of independence and establish what kind of help the examined patient requires.

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