Quality of Life Concepts

Secondary Health Conditions

Modified Barthel Index Score (MBI)

Description: The MBI is a measure of activities of daily living, which shows the degree of independence of a patient from any assistance. It covers 10 domains of functioning (activities): bowel control, bladder control, as well as help with grooming, toilet use, feeding, transfers, walking, dressing, climbing stairs, and bathing.

Format: A 10-item scale where each activity is given one of five levels of dependency ranging from 0 (unable to perform task) to a maximum of 5, 10, or 15 (fully independent). 

Scoring: Each activity is given a score ranging from 0 (unable to perform task) to a maximum of 5, 10, or 15 (fully independent- exact score depends on the activity being evaluated). A total score is obtained by summing points for each of the items. Total scores may range from 0 to 100, with higher scores indicating greater independence. It should be noted, however, that dependency scores have been established for stroke populations, so they do not necessarily transfer to persons with spinal cord injury (SCI). Scores based on the past 48 hours are preferred.

Administration and Burden: Observation; Self-report; Responses from family/friends. Approximately 10 minutes, but may take longer if completed through observation alone.

Psychometrics for SCI: The MBI has been shown to be highly valid and reliable. The internal consistency of the MBI in SCI patients is good (α = 0.88–0.90). The inter-rater reliability is sufficient at the item level (kappa 0.50–0.78) and good for the overall inter-rater agreement (intraclass correlation coefficient [ICC] 0.77) [1, 2].  There is no test-retest information available and no signal:noise ratio information. In addition, environmental changes can bias/influence the results [1, 2].  Convergent criterion-related validity for SCI has been demonstrated by relating the MBI to the ASIA impairment scale and to ASIA motor (Spearman's correlation coefficient was 0.55 at admission and 0.76 at discharge) and sensory score (Spearman's correlation coefficient 0.43 at admission and 0.51 at discharge) [2].  For a full review of the MBI psychometric properties for SCI, please see Anderson et al. [3].

Languages: Chinese; Turkish. Only the English version has been assessed for the SCI population.

QoL Concept: The MBI is a measure of Functional Status, which corresponds to Boxes B (societal standards and priorities) and C (achievements; activities of daily living) of Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; The Maryland State Medical Society holds the copyright for the Barthel Index. It may be used freely for non-commercial purposes with the following citation:

Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14: 56-61. Used with permission.

Permission is required to modify the Barthel Index or to use it for commercial purposes.

The MBI can be obtained from http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-transition-claimadvance.htm~ageing-transition-claimadvance03.htm

References:

  1. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989;42:703–9.

  2. Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med 2000;32:87-92.

  3. Anderson K et al. Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med 2008;31:133-44.

CLICK ON THE LISTED SECONDARY HEALTH CONDITIONS ON THE LEFT TO READ HOW THE MBI HAS BEEN USED WITH A PARTICULAR CONDITION


Bowel Dysfunction SCI Studies: One cross-sectional survey.

  1. Han TR, Kim JH, Kwon BS. Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury. Spinal Cord 1998;36:485-90.

Sensitivity to Impact: Han et al. (1998) used the Modified Barthel Index (MBI) as a measure of global level of independence and used a study-specific questionnaire to investigate the characteristics of chronic gastro-intestinal (GI) problems and bowel dysfunction in patients with spinal cord injury (SCI) (N = 72). Results showed that GI problems post-SCI consisted mainly of bowel problems, such as defecation difficulty. In addition, bowel dysfunction was unrelated to characteristics such as age, duration and neurological level of SCI, or level of activity.

Suggestions for Use: The MBI suffers from floor and ceiling effects [1]. Also has been criticized for not including important aspects of functional independence such as cognition, language, and pain. In addition, it does not properly differentiate disability among patients with higher levels of functioning. Scoring is not on a metric scale, nor on a true interval scale, so one cannot directly compare scores of two patients (e.g., say that one patient is twice as independent as another). The MBI shares more commonalities with functional outcome measures (e.g., Functional Independence Measure [2]) than with QoL measures.  The bowel and bladder items are mostly focused on the presence/absence of incontinence and, therefore, cannot not be sensitive enough to changes in management for SCI individuals [3].  As such, it may be more useful to use the MBI to ascribe some description of bowel dysfunction, but not necessarily to assess its impact per se.

Additional References:

  1. Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil 1979; 60:145-54.

  2. Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6-18.

  3. Anderson K et al. Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med 2008;31:133-44.

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