Determinants of handicap 1 and 3 years after a stroke

A total of 361 consecutive admissions to hospital with acute stroke were followed up to examine the determinants of handicap 1 year and 2-3 years later. Handicap was measured using the London Handicap Scale, and data were collected on initial stroke severity, disability, mood and sociodemographic variables. Ninety-five of 170 survivors returned handicap questionnaires at 1 year, 102 of 149 survivors at 2-3 years, and 58 on both occasions. Mean handicap score decreased slightly between 1 and 2-3 years (45-48 on a 0-100 scale, 95% confidence interval for difference -1 to +7, p = 0.09). At both 1 and 2-3 years handicap was associated with pre-stroke disability, 1-year score disability, initial stroke severity and mood. Age and sex were associated at 1 year but not at 2-3 years. In multivariate analyses disability, stroke severity and mood were independently associated with handicap. None of the variables examined predicted change in handicap score. The study demonstrates the overriding importance of stroke severity (impairment) and disability in determining handicap. In comparison, social variables were less important.