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Total (0-100): The Barthel ADL Index: Guidelines 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 Patient performance should be established using the best available evidence provided by the patient, family, friends and caregivers; direct observation and common sense are also important, but direct testing is not needed Usually the patient's performance over the preceding 24 to 48 hours is important, but occasionally longer periods will be relevant Middle categories imply that the patient supplies over 50 percent of the effort Use of aids to be independent is allowed References: Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Maryland State Medical Journal 1965; 14:56. Used with permission. Loewen SC, Anderson BA. Predictors of stroke outcome using objective measurement scales. Stroke 1990; 21:78. Gresham GE, Phillips TF, Labi ML. ADL status in stroke: relative merits of three standard indexes.” Arch Phys Med Rehabil 1980; 61:355. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disability Study 1988; 10:61.