Barthel Index
Mahoney & Barthel et al‚ 1965
شاخص بارتل
1. Feeding (if food needs to be cut up = help)
2. Moving from wheelchair to bed and return (includes sitting up in bed)
3. Personal toilet (wash face‚ comb hair‚ shave‚ clean teeth)
4. Getting on and off toilet (handling clothes‚ wipe‚ flush)
5. Bathing self
6. Walking on level surface (or if unable to walk‚ propel wheelchair) *score only if unable to walk
7. Ascend and descend stairs
8. Dressing (includes tying shoes‚ fastening fasteners)
9. Controlling bowels
10.Controlling bladder
نسخه 15 ماده ای
Granger et al‚ 1981
1. Drink from cup/feed from dish
2. Dress upper body
3. Dress lower body
4. Don brace or prosthesis
5. Grooming
6. Wash or bathe
7. Bladder continence
8. Bowel continence
9. Care of perineum/clothing at toilet
10.Transfer‚ chair
11.Transfer‚ toilet
12.Transfer‚ tub or shower
13.Walk on level 50 yards or more
14.Up and down stairs for one flight or more
15.Wheelchair/50 yards—only if not walking
شرح سایت روان سنجی: شاخص بارتل برای اندازه گیری استقلال عملکرد و پویایی فرد برای نظارت بر عملکرد بلند مدت بیماران در بیمارستان ، قبل و بعد از درمان و برای مشخص کردن میزان مراقبت پرستاری مورد نیاز پدید آمده است. همچنین برای برآورد پیش آگهی، پیش بینی پیامدهاو ارزیابی در بیماران با شرایط فلج و توان بحشی برای بلند مدت به کار گرفته شده است.
دو نسخه وجود دارد، یک نسخه اصلی با ده گویه و یک نسخه 15 گویه ای که توسط "گرانجر، 1979" پیشنهاد شده است.
اعتبار: هماهنگی درونی ،0.87 تا 0.92 برای نمره گذاری اصلی و 0.9 تا 0.93 برای نمره گذاری بازنگری شده (شاه و همکاران، 1989)
نمره گذاری: نمره گذاری ده فعالیت توسط متخصص انجام می شود. (مک داول، 2006 را ببینید)
1. Feeding
10 = Independent. The patient can feed himself a meal from a tray or table when someone puts the food within his reach. He must put on an assistive device if this is needed‚ cut up the food‚ use salt and pepper‚ spread butter‚ etc. He must accomplish this in a reasonable time.
5 = Some help is necessary (when cutting up food‚ etc.‚ as listed above).
2. Moving from wheelchair to bed and return
15 = Independent in all phases of this activity. Patient can safely approach the bed in his wheelchair‚ lock brakes‚ lift footrests‚ move safely to bed‚ lie down‚ come to a sitting position on the side of the bed‚ change the position of the wheelchair‚ if necessary‚ to transfer back into it safely‚ and return to the wheelchair.
10 = Either some minimal help is needed in some step of this activity or the patient needs to be reminded or supervised for safety of one or more parts of this activity.
5 = Patient can come to sitting position without the help of a second person but needs to be lifted out of bed‚ or if he transfers‚ with a great deal of help.
3. Doing personal toilet
5 = Patient can wash hands and face‚ comb hair‚ clean teeth‚ and shave. He may use any kind of razor but must put in blade or plug in razor without help as well as get it from drawer or cabinet. Female patients must put on own make-up‚ if used‚ but need not braid or style hair.
4. Getting on and off toilet
10 = Patient is able to get on and off toilet‚ fasten and unfasten clothes‚ prevent soiling of clothes‚ and use toilet paper without help. He may use a wall bar or other stable object of support if needed. If it is necessary to use a bed pan instead of a toilet‚ he must be able to place it on a chair‚ empty it‚ and clean it.
5 = Patient needs help because of imbalance or in handling clothes or in using toilet paper.
5. Bathing self
5 = Patient may use a bathtub‚ a shower‚ or take a complete sponge bath. He must be able to do all the steps involved in whichever method is employed without another person being present.
6. Walking on a level surface
15 = Patient can walk at least 50 yards without help or supervision. He may wear braces or prostheses and use crutches‚ canes‚ or a walkerette but not a rolling walker. He must be able to lock and unlock braces if used‚ assume the standing position and sit down‚ get the necessary mechanical aids into position for use‚ and dispose of them when he sits. (Putting on and taking off braces is scored under dressing.)
10 = Patient needs help or supervision in any of the above but can walk at least 50 yards with a little help.
6a. Propelling a wheelchair
5 = Patient cannot ambulate but can propel a wheelchair independently. He must be able to go around corners‚ turn around‚ maneuver the chair to a table‚ bed‚ toilet‚ etc. He must be able to push a chair a least 50 yards. Do not score this item if the patient gets score for walking.
7. Ascending and descending stairs
10 = Patient is able to go up and down a flight of stairs safely without help or supervision. He may and should use handrails‚ canes‚ or crutches when needed. He must be able to carry canes or crutches as he ascends or descends stairs.
5 = Patient needs help with or supervision of any one of the above items.
8. Dressing and undressing
10 = Patient is able to put on and remove and fasten all clothing‚ and tie shoe laces (unless it is necessary to use adaptations for this). The activity includes putting on and removing and fastening corset or braces when these are prescribed. Such special clothing as suspenders‚ loafer shoes‚ dresses that open down the front may be used when necessary.
5 = Patient needs help in putting on and removing or fastening any clothing. He must do at least half the work himself. He must accomplish this in a reasonable time.
Women need not be scored on use of a brassiere or girdle unless these are prescribed garments.
9. Continence of bowels
10 = Patient is able to control his bowels and have no accidents. He can use a suppository or take an enema when necessary (as for spinal cord injury patients who have had bowel training).
5 = Patient needs help in using a suppository or taking an enema or has occasional accidents.
10. Controlling bladder
10 = Patient is able to control his bladder day and night. Spinal cord injury patients who wear an external device and leg bag must put them on independently‚ clean and empty bag‚ and stay dry day and night.
5 = Patient has occasional accidents or cannot wait for the bed pan or get to the toilet in time or needs help with an external device.
Collin and Wade Scoring and Guidelines for the 10-Item Modified Barthel Index
General
The Index should be used as a record of what a patient does‚ NOT as a record of what a patient could do.
The main aim is to establish degree of independence from any help‚ physical or verbal‚ however minor and for whatever reason.
The need for supervision renders the patient NOT independent.
A patient’s performance should be established using the best available evidence. Asking the patient‚ friends/relatives and nurses will be the usual source‚ but direct observation and common sense are also important. However‚ direct testing is not needed.
Usually the performance over the preceding 24–48 hours is important‚ but occasionally longer periods will be relevant.
Unconscious patients should score “0” throughout‚ even if not yet incontinent.
Middle categories imply that patient supplies over 50% of the effort.
Use of aids to be independent is allowed.
Bowels (preceding week)
0 = incontinent (or needs to be given enemata)
1 = occasional accident (once/week)
2 = continent
If needs enema from nurse‚ then ‘incontinent.’
Occasional = once a week.
Bladder (preceding week)
0 = incontinent‚ or catheterized and unable to manage
1 = occasional accident (max. once per 24 hours)
2 = continent (for over 7 days)
Occasional = less than once a day.
A catheterized patient who can completely manage the catheter alone is registered as ‘continent.’
Grooming (preceding 24–48 hours)
0 = needs help with personal care
1 = independent face/hair/teeth/shaving (implements provided)
Refers to personal hygiene: doing teeth‚ fitting false teeth‚ doing hair‚ shaving‚ washing face. Implements can be provided by helper.
Toilet use
0 = dependent
1 = needs some help‚ but can do something alone
2 = independent (on and off‚ dressing‚ wiping). Should be able to reach toilet/commode‚ undress sufficiently‚ clean self‚ dress and leave
With help = can wipe self‚ and do some other of above.
Feeding
0 = unable
1 = needs help cutting‚ spreading butter etc.
2 = independent (food provided in reach). Able to eat any normal food (not only soft food). Food cooked and served by others. But not cut up.
Help = food cut up‚ patient feeds self.
Transfer (from bed to chair and back)
0 = unable—no sitting balance
1 = major help (one or two people‚ physical)‚ can sit
2 = minor help (verbal or physical)
3 = independent
Dependent = no sitting balance (unable to sit); two people to lift.
Major help = one strong/skilled‚ or two normal people. Can sit up.
Minor help = one person easily‚ OR needs any supervision for safety.
Mobility
0 = immobile
1 = wheelchair independent including corners etc.
2 = walks with help of one person (verbal or physical)
3 = independent (but may use any aid‚ e.g.‚ stick)
Refers to mobility about the house or ward‚ indoors. May use aid. If in wheelchair‚ must negotiate corners/doors unaided.
Help = by one‚ untrained person‚ including supervision/moral support.
Dressing
0 = dependent
1 = needs help‚ but can do about half unaided
2 = independent (including buttons‚ zips‚ laces‚ etc.)
Should be able to select and put on all clothes‚ which may be adapted.
Half = help with buttons‚ zips‚ etc. (check!)‚ but can put on some garments alone.
Stairs
0 = unable
1 = needs help (verbal‚ physical‚ carrying aid)
2 = independent up and down
Must carry any walking aid used to be independent.
Bathing
0 = dependent
1 = independent (or in shower)
Usually the most difficult activity.
Must get in and out unsupervised‚ and wash self.
Independent in shower = “independent” if unsupervised/unaided.
Total (0–20)
چگونگی دستیابی
منبع برای آگاهی بیشتر
Mahoney‚ FI.‚ Wood‚ OH.‚ Barthel‚ DW. (1958). Rehabilitation of chronically ill patients: the influence of complications on the final goal. South Med J‚ 51:605–609.
Mahoney‚ FI.‚ Barthel‚ DW. (1965). Functional evaluation: the Barthel Index. Maryland State Med J‚14:62.
Shah‚ S.‚ Vanclay‚ F.‚ Cooper‚ B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol‚ 42:703–709.
Granger‚ CV.‚ Albrecht‚ GL.‚ Hamilton‚ BB. (1979). Outcome of comprehensive medical rehabilitation: measurement by PULSES Profile and the Barthel Index. Arch Phys Med Rehabil‚ 60:145–154.
Granger‚ CV. (1982).Health accounting functional assessment of the long-term patient. In: Kottke FJ‚ Stillwell GK‚ Lehmann JF‚ eds. Krusen’s handbook of physical medicine and rehabilitation. 3rd ed. Philadelphia: WB Saunders‚253–274.
Collin‚ C.‚ Wade‚ DT.‚ Davies‚ S‚ et al. (1988). The Barthel ADL Index: a reliability study. Int Disabil Stud‚ 10:61–63.
Granger‚ CV.‚ Hamilton‚ BB.‚ Gresham‚ GE.‚ et al. (1989). The stroke rehabilitation outcome study: Part II. Relative merits of the total Barthel Index score and a four-item subscore in predicting patient outcomes. Arch Phys Med Rehabil‚ 70:100–103
McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS