Modified Berthel Index Form
ADVERTISEMENT
1
2
3
4Appendix 3
MODIFIED BARTHEL INDEX (SHAH VERSION) : SELF CARE ASSESSMENT
INDEX ITEM
SCORE
DESCRIPTION
0
Unable to participate in a transfer. Two attendants are required to transfer the
patient with or without a mechanical device.
3
Able to participate but maximum assistance of one other person is require in all
aspects of the transfer.
8
The transfer requires the assistance of one other person. Assistance may be
required in any aspect of the transfer.
CHAIR/BED TRANSFERS
12
The presence of another person is required either as a confidence measure, or to
provide supervision for safety.
15
The patient can safely approach the bed walking or in a
wheelchair, lock brakes, lift footrests, or position walking aid, move safely to bed,
lie down, come to a sitting position on the side of the bed, change the position of
the wheelchair, transfer back into it safely and/or grasp aid and stand. The patient
must be independent in all phases of this activity.
0
Dependent in ambulation.
3
Constant presence of one or more assistant is required during ambulation.
Assistance is required with reaching aids and/or their manipulation. One person is
8
required to offer assistance.
The patient is independent in ambulation but unable to walk 50 metres without
12
help, or supervision is needed for confidence or safety in hazardous situations.
AMBULATION
The patient must be able to wear braces if required, lock and unlock these braces
assume standing position, sit down, and place the necessary aids into position for
15
use. The patient must be able to crutches, canes, or a walkarette, and walk 50
metres without help or supervision.
0
Dependent in wheelchair ambulation.
1
Patient can propel self short distances on flat surface, but assistance is required for
AMBULATION/WHEELCHAIR
all other steps of wheelchair management.
3
Presence of one person is necessary and constant assistance is required to
manipulate chair to table, bed, etc.
* (If unable to walk)
4
The patient can propel self for a reasonable duration over regularly encountered
Only use this item if the
terrain. Minimal assistance may still be required in “tight corners” or to negotiate
a kerb 100mm high.
patient is rated “0” for
Ambulation, and then
only if the patient has
5
To propel wheelchair independently, the patient must be able to go around corners,
been trained in
turn around, manoeuvre the chair to a table, bed, toilet, etc. The patient must be
wheelchair management.
able to push a chair at least 50 metres and negotiate a kerb.
9
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical