How to reference the Barthel Index? A comprehensive guide for academic writing

The Barthel Index, a cornerstone of functional assessment, is used in countless clinical and research settings worldwide. To maintain academic and professional integrity, understanding how to reference the Barthel Index accurately is essential for researchers, students, and clinicians alike.

Quick Summary

Properly referencing the Barthel Index involves citing the original 1965 publication by Mahoney and Barthel, typically formatted according to the specific academic style guide being used, such as APA or AMA, and noting any modifications to the tool.

Key Points

• Cite the Original Work: Always include the 1965 Mahoney and Barthel paper for the foundational index, regardless of the version you used.

• Reference Modified Versions: If using a version other than the original, you must also cite the publication that introduced the modification, such as the Shah (1989) or Collin et al. (1988) versions.

• Follow Style Guide Rules: Adhere to the specific formatting requirements of your chosen citation style, like APA, AMA, or Chicago, for both in-text citations and reference list entries.

• Provide Methodological Clarity: Explicitly state which version of the Barthel Index was used within your methodology section to ensure accuracy and reproducibility of your work.

• Use for Non-Commercial Purposes: The Barthel Index can be used freely for non-commercial purposes, but modifications require specific permission from the copyright holder, the Maryland State Medical Society.

Understanding the Barthel Index and Its Origins

The Barthel Index (BI) is a widely used ordinal scale for measuring an individual's performance in activities of daily living (ADL). It was developed by Dorothea Barthel, a physical therapist, and Florence Mahoney, a physician, in 1965 to assess the functional independence of patients with neuromuscular or musculoskeletal disorders. The original index evaluated 10 core self-care and mobility tasks, such as feeding, bathing, and ambulation.

Since its inception, the BI has undergone various modifications and adaptations, leading to versions like the Modified Barthel Index (MBI). The need to reference the original work correctly, alongside any specific modifications, is critical for documenting the precise version of the tool used in a study or clinical report.

Referencing the Original Barthel Index (1965)

For most academic and clinical purposes, the proper way to cite the Barthel Index is to reference the original 1965 publication in the Maryland State Medical Journal. This ensures that credit is given to the foundational work and provides readers with the primary source.

APA Style Citation (7th Edition)

In APA style, the citation for the original Barthel Index article should be formatted as follows:

• Reference List Entry: Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.
• In-text citation: (Mahoney & Barthel, 1965).

AMA Style Citation (11th Edition)

For AMA style, commonly used in medical and scientific publications, the format is slightly different:

• Reference List Entry: Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Maryland State Medical Journal. 1965;14:56-61.
• In-text citation: (Mahoney and Barthel, 1965) or simply the superscript number corresponding to the reference list entry.

Chicago Style Citation (17th Edition)

In Chicago style, two formats are possible: Notes-Bibliography and Author-Date. For the Author-Date format, it would look like this:

• Reference List Entry: Mahoney, Florence I., and Dorothea W. Barthel. 1965. “Functional Evaluation: The Barthel Index.” Maryland State Medical Journal 14: 61–65.
• In-text citation: (Mahoney and Barthel 1965).

Referencing Modified Versions of the Barthel Index

When using a modified version, such as the Modified Barthel Index (MBI), it is important to cite both the original publication and the paper that introduced the modification. This provides full context for the tool being used.

Referencing the Shah Modification

The Shah modification, which uses a 5-level ordinal scale for each item to improve sensitivity, was introduced in 1989. A proper reference would include both the original and the modified version's source.

Example (APA Style)

• Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.
• Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.

In-text: (Mahoney & Barthel, 1965; Shah et al., 1989).

Referencing the Collin et al. Modification

The Collin et al. modification is a 10-item version with a different scoring system.

Example (AMA Style)

• Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Maryland State Medical Journal. 1965;14:56-61.
• Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61-63.

In-text: (Mahoney and Barthel, 1965; Collin et al., 1988).

Comparison of Citing Original vs. Modified Barthel Index

Aspect	Citing the Original (1965)	Citing a Modified Version (e.g., MBI)
Purpose	To reference the foundational work and original methodology.	To indicate the specific version of the tool used, which may have different scoring or items.
References	Only the Mahoney and Barthel (1965) paper.	The Mahoney and Barthel (1965) paper, plus the publication that introduced the modification.
Detail Provided	Establishes the historical context of the tool.	Provides full methodological transparency for the exact assessment used.
Example APA	(Mahoney & Barthel, 1965)	(Mahoney & Barthel, 1965; Shah et al., 1989)
Example AMA	Mahoney FI, Barthel D. (1965)	Mahoney FI, Barthel D. (1965); Shah S et al. (1989)
Best Practice	Use for historical context or when using the precise original method.	Use when your research or clinical application relies on a specific modified scoring system or item set.

Best Practices for Referencing the Barthel Index

1. Always cite the original source: Even if using a modified version, citing Mahoney and Barthel (1965) is a standard practice that honors the original developers.
2. State the specific version: In your methodology or text, explicitly state whether you used the original Barthel Index or a modified version. This clarity is crucial for reproducibility and interpretation of your work.
3. Consult your target publication's guidelines: Different journals have different requirements for citing. Always check the specific style guide (e.g., APA, AMA, MLA, Chicago) mandated by the publisher. For AMA, referencing specific versions like the MBI is essential.
4. Reference the developers of modified versions: When a modified version is used, find and cite the paper or source that first described that particular modification. This is critical for crediting the work of those who adapted the tool.

For more detailed guidance on a variety of clinical assessments, including the Barthel Index, visit the Physiopedia page on the Barthel Index. This is an authoritative resource for clinicians and researchers.

Conclusion

Accurately referencing the Barthel Index is a key aspect of rigorous academic and clinical practice. It involves acknowledging the foundational work of Mahoney and Barthel while also providing precise details on any modified versions utilized. Following the appropriate style guide—be it APA, AMA, or Chicago—and including all relevant references ensures transparency and proper attribution. This practice not only upholds academic integrity but also helps readers understand the specific methodology applied, which is vital for the reproducibility of research and proper clinical assessment interpretation. By adhering to these citation rules, healthcare professionals and researchers can confidently and accurately document their use of this important functional assessment tool.

Frequently Asked Questions

What is the correct way to cite the original Barthel Index in APA format?

To cite the original index in APA format, reference the 1965 publication: Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65. The in-text citation would be (Mahoney & Barthel, 1965).

How do you cite the Barthel Index if you used a modified version?

If you used a modified version, you should cite both the original 1965 Mahoney and Barthel paper and the publication that introduced the modification. For example, cite the Shah et al. (1989) paper alongside the original if you used that version.

Who holds the copyright for the Barthel Index?

The Maryland State Medical Society holds the copyright for the Barthel Index. It can be used freely for non-commercial purposes, but permission is required for modifications or commercial use.

Is it acceptable to just cite the handbook or textbook where I found the Barthel Index?

No, it is best practice to cite the original source publication by Mahoney and Barthel (1965), and any relevant modification sources, rather than a secondary source like a handbook. This provides the most accurate and authoritative reference.

What is the difference between the original and modified Barthel Index when it comes to referencing?

The core difference is that a modified version requires an additional citation for the paper that details its specific changes and scoring, in addition to the original Mahoney and Barthel reference. This helps readers understand which specific tool was used.

Can I use the Barthel Index without citing it?

No, using and referencing the Barthel Index, particularly in academic or clinical writing, requires proper citation to acknowledge the original developers and maintain academic integrity. Free use is permitted for non-commercial purposes with proper citation.

How do different citation styles (e.g., APA vs. AMA) affect referencing the Barthel Index?

The specific formatting, punctuation, and ordering of elements in the reference list will differ based on the style guide used. APA uses an authors' last name, initial, and date format, while AMA uses initials and names, with specific journal abbreviation and page number formatting.