Development and Psychometric Evaluation of a Short-form Barthel Index for Older Patients Undergoing Abdominal Surgery


  • Rinlada Pongratanakul Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Poungkaew Thitisakulchai Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Varalak Srinonprasert Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Arunotai Siriussawakul Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Patumporn Suraarunsumrit Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Piyapat Dajpratham Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand


geriatrics, Barthel index, abdominal surgery, short-form Barthel Index


Objectives: To develop and evaluate psychometric properties of a short-form of the Barthel Index.

Study design: Retrospective study.

Setting: A university hospital in Thailand.

Subjects: Patients aged 60 or over who had abdominal surgery and were enrolled in the Siriraj Integrated Perioperative Geriatric Excellent Research Center studies between January 2017 and August 2021.

Methods: Electronic medical records of patients were retrospectively reviewed and 96 patients were recruited. Items from the  Barthel index were chosen for the short-form based on importance as determined from the index of overall superiority which was obtained from each item’s total correlation score and the effect size of the item. The psychometric properties of the short-form were analyzed.

Results: The mean Barthel index score dropped from 92.8 at the time of surgery to 87.6 four weeks post-surgery. The five items with the highest ranking in the index of overall superiority were toilet use, stair climbing, bathing, mobility, and dressing. The psychometric properties of the 3-item and the 5-item versions included internal consistency (Cronbach’s alpha coefficients .72 and .84), intraclass correlation coefficient (0.72 (95%CI 0.60-0.80) and 0.74 (95%CI 0.61-0.83), and responsiveness to change (effect size 0.69 and 0.52), respectively. The 5-item version showed higher internal consistency, while the 3-item version had superior responsiveness to change.

Conclusions: We recommend the use of the 3-item version as a screening tool for detecting functional changes in older adults undergoing abdominal surgery because of its superior responsiveness to change. Additionally, it requires less assessment time  and is more practical for use in clinical practice.


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