Handicap After Stroke: How Does It Relate to Disability, Perception of Recovery, and Stroke Subtype?

Abstract

Background and Purpose-Knowledge of patterns of handicap after stroke and of the relationship among handicap, disability, perception of recovery, and stroke subtype is limited. The aim of this study was to assess handicap 3 and 12 months after first-ever stroke in a community-based study. Methods-All strokes occurring in a population of 133 816 people were found and assessed. Patients were classified as having cerebral infarction (CI) or intracerebral hemorrhage (ICH) according to imaging or autopsy findings. Cases of CI were categorized using the Oxfordshire stroke classification. Handicap, disability, and perception of recovery were assessed 3 and 12 months after stroke using the London Handicap Scale, Barthel Index, and the question "Have you made a complete recovery from your stroke?" The association between disability and handicap was examined using Pearson's correlation. Differences in handicap among subtypes of CI were evaluated using one-way ANOVA. Results-There were 264 cases of CI or ICH. Of surviving patients, 113 (59%) were assessed at 3 months and 107 (64%) at 12 months. The domains of handicap most affected were physical independence and occupation. Only half the variance in handicap was due to disability. Of patients without disability, those who claimed complete recovery were less handicapped than those who claimed incomplete recovery. Patients with total anterior circulation infarction were more handicapped at 3 and 12 months than those with other subtypes of CI. Conclusions-Stroke patients were handicapped across many domains. Handicap is only partly explained by disability.Stroke subtype should be considered in the interpretation of outcome data. Key Words: cerebral infarction Ⅲ cerebrovascular disorders Ⅲ incidence Ⅲ outcome S troke is a common disease with high mortality and high levels of disability and handicap among survivors. 1,2 Handicap is the disadvantage for an individual resulting from an impairment or disability that limits or prevents the fulfillment of a role (depending on age, sex, and social and cultural factors) that is normal for that individual. Disability is the lack of ability to perform an activity or task in the range considered normal for a human being. 3 While poststroke disability has been the subject of much discussion in the literature, handicap has received little attention. Handicap is likely to be more important to the patient than disability 3,4 and is an important target of rehabilitation. 5 Some domains of handicap are potentially modifiable, 6 but knowledge of which aspects of handicap are most affected in stroke survivors is limited. A better understanding of patterns of handicap after stroke and the relationship of disability, handicap, and patients' overall perception of recovery may help in the planning of rational and cost-effective interventions in the setting of limited resources.Stroke has usually been regarded as a global entity when the outcome of survivors has been assessed. 7-10 However, mortality patterns differ with stroke subtype, and there is ...

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