Handicap one year after a stroke: validity of a new scale

The aim was to determine the handicap experienced by subjects one year after a stroke, and assess the acceptability, validity, and reliability of a new handicap measurement scale. A cross sectional survey of 141 survivors of a cohort of consecutive hospital admissions with acute stroke was undertaken. The London handicap scale (a new health outcome measurement scale), Barthel index, Nottingham extended activities of daily living scale, Nottingham health profile, Geriatric depression score, and a global life satisfaction scale were used. 94 subjects (67%) responded to a single mailing; 89 (95%) responses were usable. Mean handicap was 0.40 (range 0.06-1.0, SD 0.20) on a scale of 0 (maximum handicap) to 1 (no handicap). All handicap dimensions showed a wide range of problems, with physical independence and occupation particularly affected. Correlations between handicap score and other outcome measures were all in the expected direction and of about the strength expected (0.36 < r < 0.69). The reliability coefficient was 0.91, limits of agreement +/- 0.19. The measurements demonstrated substantial handicap one year after a stroke, reflecting considerable unmet rehabilitation needs. The scale proved acceptable to subjects, and the results were consistent with good validity.