The Spanish versions of the Barthel index (BI) and the Katz index (KI) of
activities of daily living (ADL): A structured review
, Julio Cabrero-Garcı
a, Miguel Richart-Martı
Carmen Luz Mun
Nursing Department, University of Alicante, Carretera de San Vicente s/n, 03690 San Vicente del Raspeig, Alicante, Spain
The activities of daily living (ADL) are the main focus of the
measures of health and quality of life of the elderly (Spector and
Fleishman, 1998). In the Gerontological research, the inclusion of
the ADL measures as indicators of functional disability is almost as
common as age, gender and marital status (Rodgers and Miller,
1997). Functional disability is the main predictor, after age, of
important results: mortality, the use of health services and
institutionalization, the incidence of acute diseases, falls and
injuries, and the deterioration of the functional capacity (Guralnik
et al., 1996).
The measures of ADL include the subdomains of self-care and
mobility (Wiener et al., 1990; Avlund, 1997). Among the
instruments of ADL, from their development to present time,
the BI and the KI ADL have turned into standards of measures in the
research into old people (Ciesla et al., 1993; Sainsbury et al., 2005).
The ﬁrst one was developed initially by Mahoney and Barthel
(1965) for the assessment and monitoring of the functional
capacity of patients with neuromuscular or musculoskeletal
disorders at the chronic disease hospitals in Maryland. The second
one was elaborated by the staff at Benjamin Rose Hospital from
observations of a large number of activities performed by a group
of patients with fracture of the hip and later on old people and
chronic patients (Katz et al., 1963).
The BI is an instrument of clinical application, which can be
administered by a member of the medical staff, in 2–5 min or self-
administered in about 10 min and it has been used in many studies.
Whereas the evidence of its reliability is excellent, the evidence of
its validity is only satisfactory (McDowell, 2006). The KI is also a
clinical measure, administered by a member of the staff and widely
used. However, the information about its reliability is very basic
and weak, whereas its validity is considered adequate, even though
only a few types of validity have been examined or just a few
studies report about it (McDowell, 2006).
Haywood et al. (2004) revised the measures of the status of
health in the elderly, but the measures of speciﬁc domain were not
included, like for example those of ADL/IADL (instrumental ADL).
The most recent revision of any of these scales is the one by
Sainsbury et al. (2005) about the reliability of the BI.
In Spanish literature, a review of health measures concluded
that the KI (the Spanish version) had a low level of development,
solely reporting ﬁndings about its reliability, in just one study. The
BI was not included in that review (Badı
a et al., 2002).
The aim of this article was evaluating the evidence related to
the appropriateness to the target population, practicality and
psychometric properties of the BI and the KI of ADL in Spanish
Archives of Gerontology and Geriatrics 49 (2009) e77–e84
Received 16 April 2008
Received in revised form 8 September 2008
Accepted 11 September 2008
Available online 5 November 2008
Katz index of activities of daily living
Functional assessment of older people
In this article, the evidence relating to the appropriateness to the target population, practicality and
psychometric properties of the BI and the KI of ADL on samples of Spanish old people has been evaluated.
To obtain the original documents electronic searches were carried out in Spanish databases and in
international databases, MEDLINE, PsycInfo, CINAHL and EMBASE, as well as manual searches and
references searches. Twenty articles met the inclusion criteria. The results show a large number of
versions, for the two instruments, with weak processes of transcultural adaptation, without standards for
its administration, nor for its interpretability. The most evaluated point of reliability was the interrater
reproducibility. The evidence about predictive validity is extensive, but the evidence about concurrent
validity and responsiveness is very scarce.
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* Corresponding author. Tel.: +34 965 903 400x2102; fax: +34 965 903 516.
E-mail address: Mariajose.email@example.com (M.J. Caban
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