Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living

ADL dependence for chair-to-bed transfers is an independent risk factor for mortality for any level of dependency. Therefore, a new classification of the Barthel index is proposed, in which "being dependent or requiring great assistance to perform chair-to-bed transfers" is considered severe dependence, even when the total score obtained via the Barthel Index is ≥40. We propose its use as a screening test in parallel to the Barthel index. The study suggests that the Barthel Index may have limitations in adequately discriminating mortality risk.