巴塞尔指数

注意！该文章为贵州三易医疗器械有限公司原创整理编辑，不经过本公司书面同意，不得以任何方式，包括但不限于电子、纸质的方式进行复制、传播及转载。原始发布时间：2026年8月29日。

巴塞尔指数概况

巴塞尔指数（Barthel Index，BI）由Mahoney和Barthel于1965年首次开发，用于测量个体在日常生活活动（ADL）中的独立功能与活动能力，涉及进食、洗澡、修饰、穿衣、大便控制、小便控制、如厕、椅子转移、行走和上下楼梯10个方面。该指数还可提示护理协助需求，是应用广泛的功能残疾测量工具。量表最初为脑卒中及其他神经肌肉或肌肉骨骼疾病康复患者开发，也可用于肿瘤患者。1988年Collin、Wade、Davies和Horne对其进行了修订。

巴塞尔指数的目的

巴塞尔指数旨在测量个体在日常生活活动中能够独立活动的程度，并指示所需的护理协助水平，从而评估脑卒中及其他神经肌肉、肌肉骨骼疾病患者及肿瘤患者的功能残疾状况和自理能力。

巴塞尔指数的测试项目与分量表

原始版本包含10个条目：

进食
洗澡
修饰
穿衣
大便控制
小便控制
如厕
椅子转移
行走
上下楼梯

各条目按个体能否独立完成、需部分协助或依赖评分为10分、5分或0分，条目按所需护理水平加权。该量表通常无分量表。

巴塞尔指数的施测规则

巴塞尔指数可通过自我评定、直接观察或电话施测完成，也可由代理人代答。研究表明未经培训与经过培训的人员施测信度相同。75岁以上患者不推荐自评。电话施测也被证明可靠。

巴塞尔指数的评分方法

总分为各条目累加，其中移动能力和二便控制享有优先权重：

洗澡和修饰：每项0或5分
进食、穿衣、大便控制、小便控制、如厕、上下楼梯：每项0、5或10分
转移和活动：每项0、5、10或15分

总分0-100分，分数越高表示功能独立性越高。计分仅需手工简单加总。

Shah、Vanclay和Cooper（1989）提出5级评分修改版：1分为无法完成任务，2分为尝试完成任务但不安全，3分为需中等帮助，4分为需最小帮助，5分为完全独立。其分级标准为：0-20分为完全依赖，21-60分为重度依赖，61-90分为中度依赖，91-99分为轻度依赖。

巴塞尔指数的测试时间

自评需2-5分钟；直接观察最长需20分钟，视患者能力与耐受性而定。

进行巴塞尔指数测试之前需要进行培训吗？

施测无需培训，熟练与非熟练人员施测信度相同。量表可自评，但75岁以上患者不推荐自评；也可通过电话可靠施测。

巴塞尔指数需要什么样的设备？

仅需一支铅笔和测试条目。

巴塞尔指数适合哪些患者群体使用？

可用于脑卒中患者，是卒中结局评估的常用工具，已被证实为基本日常生活活动的可靠有效测量工具；也可用于其他神经肌肉或肌肉骨骼疾病患者及肿瘤患者。总分可预测住院时长。该量表无使用前提条件，可由代理人完成，也可电话施测。

该量表不应用于捕捉较高水平身体功能的显著丧失或家庭、社区独立生活所需的活动，患者可能得满分100分仍存在明显损害；对轻度脑卒中患者需谨慎使用，虽对变化有反应性，但存在明显天花板效应。

巴塞尔指数的心理测量学特性

地板和天花板效应方面：一项针对50例首次脑卒中后残留步态缺损患者的研究显示，卒中后8天和38天天花板效应最显著，分别为28%和56%；一项95例脑卒中患者的研究显示，入院地板效应良好（5%），出院天花板效应差（27%）；一项118例脑卒中住院康复患者的研究显示，修改版量表入院地板效应为18.2%、出院为4.7%（良好），天花板效应为0%（优秀）。

信度方面：内部一致性方面，一项149例神经系统疾病患者研究报告修改版Cronbach系数alpha为0.94（优秀）；一项118例脑卒中患者研究报告修改版与FIM运动分量表alpha不低于0.84（优秀）；一项258例脑卒中患者研究报告alpha为0.90（优秀）；中文版与英文版修改版alpha分别为0.93和0.92（优秀）；一项121例台湾脑卒中患者研究在4个时间点报告alpha为0.89-0.92（优秀）。重测信度方面，一项22例脑卒中后至少1年患者的研究显示修改版总体一致性为75%和85%，但kappa值变异较大。评定者间信度方面：一项15例脑卒中患者的研究显示中文版优秀（kappa为0.81-1.00），英文版良好至优秀（kappa为0.63-0.85）；一项系统综述加荟萃分析纳入10项研究，8项优秀、2项良好（组内相关系数0.94-0.96；kappa为0.62-0.90；加权kappa为0.70-0.99）；一项7例脑卒中患者的研究显示评定者间组内相关系数为0.96、评定者内为0.99（均优秀）；一项台湾患者研究显示条目间加权kappa为0.53-0.94，总分组内相关系数为0.94；波斯语版加权kappa为0.99（优秀）；巴西脑卒中患者研究为良好（kappa为0.70）。

效度方面：内容效度在脑卒中患者中无研究。同时效度方面，一项118例患者的研究显示修改版与FIM运动分量表入院相关r=0.92、出院r=0.94（优秀）。预测效度方面：一项研究显示第7天修改版15-18分者比低于15分者更可能恢复尿失禁（比值比为21.8）；一项677例患者的研究显示中重度残疾者跌倒风险增加（比值比为2.59）；一项330例患者的研究显示修改版每降1分约对应住院时长增加约1天；一项研究确定最小临床重要差异在0-20分制上提高不低于1.85分为有意义变化（仅适用于改善）。结构效度方面，一项106例患者的研究显示其与SF36身体功能相关r=0.81、与诺丁汉健康量表身体活动相关r=0.840、与法国ay活动指数相关r=0.826（均优秀），建议配合心理社会维度量表使用；一项121例患者的研究显示其与Fugl-Meyer评估相关r为0.78-0.81、与博格平衡量表相关r为0.89-0.94（均优秀）。

反应性方面：一项167例患者的研究显示其比Fugl-Meyer评估更敏感；一项50例患者的研究显示标准化反应均数为0.99（大）；一项118例患者的研究显示标准化反应均数为1.2（高反应性）；一项372例患者的研究显示效应量为0.31（小）。总体而言，巴塞尔指数存在显著天花板效应，对高功能个体的变化检测不佳；8项研究中3项报告大反应性、3项良好、2项小。

巴塞尔指数的版本

目前存在多个替代版本：

修改版10项版本（MBI，Collin等，1988）：各项0-1、0-2或0-3分（视条目而定），总分0-20分
5项简版（Hobart和Thompson，2001）：包含转移、洗澡、如厕、上下楼梯、活动5类，总分0-20分，与原版相关r=0.90，心理测量学等效
15项扩展版（Granger等，1979）：增加4级量表，总分0-100分，60分为明显依赖阈值，与Katz指数相关r=0.78，可预测6个月后回归独立生活
扩展巴塞尔指数（EBI，Prosiegel等，1996）：16项，其中15项与FIM相同，在急性缺血性脑卒中患者中可靠有效
3项版本（Ellul等，1988）：包含床椅转移、活动、膀胱失禁3项，适用于出院时功能评估，仅在脑卒中患者中验证
自评版本：同时效度良好，与原版和FIM高度相关，重测信度足够高
早期康复巴塞尔指数（ERI，Schonle，1995）：用于评估重度脑损伤患者，在210例早期康复患者和312例重度脑损伤患者中快速、经济、可靠

关于哪个版本应被视为权威版本尚缺乏共识，但原版、10项修改版和15项扩展版最常用。该量表已有荷兰语、德语、土耳其语、波斯语、法语和中文版本。

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