Modified Barthel Index (MBI)



Based on the original Barthel Index, the Modified version by Shah, Vanclay, and Cooper (1989) is also designed to assess an individual’s ability to engage in basic activities of daily living (ADLs) by measuring level of performance and the degree of independence a person is from needing assistance to complete task items. The Modified Barthel Index (MBI) covers the same 10 domains as the original: (1) bowel control, and (2) bladder control, as well as help with (3) grooming, (4) toilet use, (5) feeding, (6) transfers, (7) walking, (8) getting dressed, (9) climbing stairs, and (10) bathing. While the BI uses only a 3-point scale the MBI uses a 5-point scale. This was done in part to address inherent floor/ceiling effects found in the original and an inability to correctly classify persons who only needed some form of assistance. The graduated scale uses the same parameters and is more sensitive to small improvements in functional independence while still maintaining the qualities of the original (Shah et al., 1989). The MBI is also scored along the same compendium as the original with 0 to 15 for each item and a total score range of 0 to 100; thus it can be said that the MBI does not cause any additional difficulty nor increase the implementation time (10 to 15 minutes) while improving the internal consistency and providing better discrimination of functional ability (Shah et al., 1989).


The MBI has been shown to have high content reliability with a Cronbach’s coefficient alpha of internal consistency of α = 0.90 recorded at the commencement of rehabilitation (Shah, et al. 1989). Kucukdeveci et al. (2000) found that the internal consistency of the MBI in spinal cord injury patients was good (α = 0.88 to 0.90) and inter-rater reliability sufficient at the item level (kappa 0.50 to 0.78) as well as good for the overall inter-rater agreement as the intra-class correlation coefficient was 0.77. The same study found correlations between the MBI and American Spinal Injury Association motor scores ranged from r = 0.58 to 0.82 excluding personal hygiene at 0.25 and feeding at 0.27, respectively. Results of the Chinese version MBI-C suggests cross-cultural stability according to data from two sets of inter-rater reliability indices that were obtained by conducting the MBI-C and the MBI concurrently on a total of 15 people with stroke. This was evidenced by the mean total scores on the MBI-C and the MBI which were similar at 57.2 (SD = 20.4) and 60.5 (SD = 22.3) (Leung, Chan, & Shah, 2007). That study also found the most inter-rater consistent item for the MBI was personal hygiene (k = 0.85) while the least consistent item was toileting (k = 0.63), whereas the most inter-rater consistent item among the MBI-C items was transfer (k = 1.00), and the least consistent item was stair climbing (k = 0.81) (Leung et al., 2007).


There is a significant amount of research in support of the MBI’s use in clinical practice. The development of the MBI was based on the work of the original Barthel Index, once a gold standard of ADL assessment. It is easy and quick to administer, 10 to 15 minutes, and there is no special training required. Scoring parameters are well thought out which has resulted in improved discriminate ability.


Possible limitations of the measure point to the fact that although the MBI builds on a significant amount of previous work relative to the original, there is limited direct evidenced-based research for a number of conditions such as neurocognitive disorders of the Alzheimer’s and related types suggesting more research is needed to definitively apply the MBI to other populations in a similar fashion as the original.


The MBI is an activity-based observational tool in which the clinician observes and grades client performance across 10 specific ADLs using a 5-item scale (range 0 to 15) where 6 items are scored as (0) unable to perform task, (2) substantial help required, (5) moderate help provided, (8) minimal help required, or (10) fully independent; 2 items scored as (0) unable to perform task, (1) substantial help required, (3) moderate help provided, (4) minimal help required, or (5) fully independent; and 2 items scored as (0) unable to perform task, (3) substantial help required, (8) moderate help provided, (12) minimal help required, or (15) fully independent (Shah, 1998; Shah et al., 1989). The cumulative score is calculated by summing each item score with higher scores suggesting a greater degree of independence in ADL functioning. The following scoring norms, as outlined by its developers, quantifies an individual’s level of dependency one might find for particular scoring ranges.

Stay updated, free articles. Join our Telegram channel

Jul 27, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Modified Barthel Index (MBI)

Full access? Get Clinical Tree

Get Clinical Tree app for offline access