On the application of the WHO handicap classification in rehabilitation

In order to study the usefulness and limitations of the WHO ICIDH Classification of handicap, a consecutive group of 76 stroke patients was studied at admission and discharge from a rehabilitation ward. All patients were graded with respect to orientation, physical independence, mobility and social integration. Most patients had at admission a combination of severe handicaps in several areas; this was less so at discharge. Nearly half of the patients did not change their degree of handicap during their stay at the rehabilitation ward. Improvement was not dependent on length of stay in the rehabilitation, age or sex. We have had difficulty in differentiating between handicap and disability as defined in the WHO system and we seriously question the utility of using three distinct categories of functional consequences of disease. We believe that the WHO system is useful to describe the type and pattern of disablement in a group of patients admitted to a rehabilitation ward and provides information on staffing demands, criteria for admittance and discharge.