The international Barthel scale is used to assess the mobility of patients. A special print of the Barthel scale is completed during the patient's qualification for long-term care in the facility. The form describes activities such as moving around, eating meals.

The Barthel scale helps to define and describe what activities the patient can perform alone and to what extent he needs help. The Barthel scale printout is completed by e.g. doctors (e.g. geriatricians) and community nurses so that the patient can be referred to a long-term care facility.

What does the Barthel scale describe?

The Barthel scale consists of ten daily activities. It is about determining which and to what extent the patient can do alone, with someone's help or at all. For each activity, points are awarded (only one option can be chosen), which must be counted at the end. The more there are, the greater the patient's independence.

The activities described in the Barthel index are:

  • Eating

0 - the patient is not able to eat on his own 5 - needs help in cutting, spreading and pouring 10 - the person is independent

  • Moving, e.g. from bed to chair, sitting down

0 - the patient is unable to move, does not maintain balance while sitting 5 - the patient needs more physical help, one or two people is needed10 - less verbal or physical help is needed15 - the person is independent

  • Personal hygiene

0 - Needs help with personal activities 5 - Patient is independent in washing his face, brushing, brushing his teeth (with help provided).

  • Using the toilet (toilet)

0 - dependent person 5 - needs some help, but can do something on their own 10 - the sick person is independent

  • Washing, bathing the whole body

0 - dependent 5 - independent (or in the shower)

  • Movement (on flat surfaces)

0 - does not move or 50 m 10 - walks with the help (verbal or physical) of one person>50 m15 - independent (but may need some help, e.g. a cane)>50 m

  • Going up and downstairs

0 - the patient is unable to 5 - needs help (verbal, physical, transfer) 10 - independent

  • Dressing and undressing

0 - dependent person5 - needs help, but can do half without help10 - independent (when fastening buttons, zipper, tying shoelaces, etc.)

  • Controlling stool / anal sphincter

0 - the patient has no control over the bowel movement (or needs enemas) 5 - he passes stools occasionally unknowingly10 - controls the bowel movement

  • Urine / Bladder Sphincter Control:

0 - the patient has no control over urination or is catheterized and therefore not self-reliant 5 - sometimes urinates (accidental events) 10 - controls urination

Barthel score

You can get a maximum of 100 points on the Barthel scale. There are three grades of assessment: getting from 0 to 20 points. means total dependence, from 20 to 80 points. means that the patient needs the help of others to some extent, and the assessment in the range of 80 to 100 points. means that with a little help the patient can function independently 0-20 points - patient's condition "very severe" 21-85 points - patient's condition "moderately severe" 86-100 points. - patient's condition "light" Obtaining 40 points on the Barthel scale or less qualifies the patient for long-term care - it means that he or she requires constant care.

Modifications to the Barthel index

The modified Barthel scale also takes into account activities that are necessary in the care and maintenance of the patient's he alth. This applies in particular to documents filled in as part of qualifications for long-term home nursing care. The evaluation sheet includes:

  • applying dressings (will stimulate wounds, bedsores and trophic ulcers)
  • drip intravenous infusions resulting from a permanent medical recommendation related to the treatment process
  • fistula feeding
  • tube feeding
  • fistula care
  • rinsing the bladder
  • tracheostomy tube care (read about tracheostomy)
  • catheter insertion and removal (regular medical prescription).
Worth knowing

Since when do we use the Barthel scale?

The Barthel scale is one of the ADL scales (Activities of Daily Living Index). They define how independent the patient is in terms of self-care. It was developed over 50 years ago for the purpose ofclinical evaluation of the treatment outcomes of stroke survivors. Currently, it is used in many other diseases, e.g. in people with neurological diseases and diseases of the osteoarticular system.

In Poland, the Barthel scale has been used since 23 December 2010 in order to grant the patient the right to guaranteed nursing and care services in the field of long-term care. The result on the Barthel scale affects the amount of financial support received from the state.

Patient qualification

The Barthel scale is used in referring patients to long-term care - both in stationary and at home. It was determined that a person who requires 24-hour nursing, care and rehabilitation services, and does not require hospitalization, may be admitted to the care facility, provided that the subject assessed on the Barthel scale obtained less than 40 points.

The duration of stay in the facility also depends on the result achieved on the Barthel scale - if it exceeds 40 points, the National He alth Fund will not finance the rest of the stay.

The scale of Barthel and the National He alth Fund: controversy

Patients, their caregivers, organizations that help people who are not fully independent, have long pointed out that the established limit of 40 points on the Barthel scale is very low. There are arguments that as many as two thirds of people who need them are denied the right to NHF benefits in this way. It is also difficult to determine the degree of dependence of a mentally disabled person, who also requires constant care, using this scale. Official interpellations were made on this matter, so far the limit of 40 points on the Barthel scale remains unchanged.

Important

The Barthel scale was developed by physiotherapist Dorothea Barthel and doctor Florence Mahoney in 1955 and published in 1965. It has been modified since then, but is still used today. The Barthel Scale is also known as: Barthel Index, Barthel Score, Maryland Disability Index.

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Patient's kit