Modified Berthel Index Form Page 2
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1
2
3
4INDEX ITEM
SCORE
DESCRIPTION
0
The patient is unable to climb stairs.
2
Assistance is required in all aspects of chair climbing, including assistance with
walking aids.
5
The patient is able to ascend/descend but is unable to carry walking aids and needs
supervision and assistance.
STAIR CLIMBING
8
Generally no assistance is required. At times supervision is required for safety due
to morning stiffness, shortness of breath, etc.
10
The patient is able to go up and down a flight of stairs safely without help or
supervision. The patient is able to use hand rails, cane or crutches when needed
and is able to carry these devices as he/she ascends or descends.
0
Fully dependent in toileting.
2
Assistance required in all aspects of toileting.
5
Assistance may be required with management of clothing, transferring, or
washing hands.
TOILET TRANSFERS
8
Supervision may be required for safety with normal toilet. A commode may be
used at night but assistance is required for emptying and cleaning.
10
The patient is able to get on/off the toilet, fasten clothing and use toilet paper
without help. If necessary, the patient may use a bed pan or commode or urinal at
night, but must be able to empty it and clean it.
0
The patient is bowel incontinent.
2
The patient needs help to assume appropriate position, and with bowel movement
facilitatory techniques.
5
The patient can assume appropriate position, but cannot use facilitatory techniques
or clean self without assistance and has frequent accidents. Assistance is required
BOWEL CONTROL
with incontinence aids such as pad, etc.
8
The patient may require supervision with the use of suppository or enema and has
occasional accidents.
10
The patient can control bowels and has no accidents, can use suppository, or take
an enema when necessary.
0
The patient is dependent in bladder management, is incontinent, or has indwelling
catheter.
2
The patient is incontinent but is able to assist with the application of an internal or
external device.
5
The patient is generally dry by day, but not at night and needs some assistance
BLADDER CONTROL
with the devices.
8
The patient is generally dry by day and night, but may have an occasional accident
or need minimal assistance with internal or external devices.
The patient is able to control bladder day and night, and/or is independent with
10
internal or external devices.
10
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