Handicap 5 years after Stroke in the North East Melbourne Stroke Incidence Study

Background: Handicap is rarely comprehensively examined after stroke. We examined handicap among 5-year stroke survivors from an ‘ideal’ stroke incidence study. Methods: Survivors were assessed with the London Handicap Scale (LHS, score range: 0 [greatest handicap] to 100 [least handicap]). Multivariable regression was used to examine demographic, risk factor and stroke-related factors associated with handicap. Results: 351 of 441 (80%) survivors were assessed. Those assessed were more often Australian born than those not assessed (p<0.05). The mean LHS score was 73 (SD 21). The greatest handicap was present for physical independence and occupation/leisure items. Handicap was associated with older age, manual occupations, smoking, initial stroke severity, recurrent stroke and mood disorders. Conclusion: Reducing recurrent stroke, through better risk factor management, is likely to reduce handicap. The association between handicap and mood disorders, which are potentially modifiable, warrants further investigation. Handicap, more recently known as ‘participation restriction’, refers to an individual’s ability to participate in everyday life situations. The London Handicap Scale (LHS) is one of few instruments designed to assess handicap according to the World Health Organization (WHO) definition [1] and has been validated for use in stroke patients.[2] The LHS was developed using the superseded WHO definition of handicap; however, others have demonstrated that it accurately measures the new WHO definition of participation restriction.[1] Studies of handicap in which investigators have used measures somewhat consistent with the WHO definition are limited.[3-10] Of these studies, only two incorporated a measure of handicap beyond 2 years post stroke,[9, 10] and only one comprised an unselected population of stroke survivors.[9] We aimed to (1) establish the pattern and level of handicap at 5 years post stroke; and (2) identify factors that are associated with handicap in 5-year stroke survivors.