Published Online
on February 12, 2004

A more recent version of this article appeared on March 1, 2004

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Submitted on November 24, 2003
Accepted on December 10, 2003

Determinants of Handicap After Stroke. The North East Melbourne Stroke Incidence Study (NEMESIS)

Jonathan W. Sturm PhD^*; Geoffrey A. Donnan MD; Helen M. Dewey PhD; Richard A.L. Macdonell MD; Amanda K. Gilligan MBBS; and Amanda G. Thrift PhD

From the National Stroke Research Institute and Department of Neurology, Central Coast Area Health, NSW (J.W.S.), and National Stroke Research Institute and Department of Neurology, Austin Health, West Heidelberg; and Department of Medicine, University of Melbourne, Melbourne, Australia (G.A.D., H.M.D., R.A.L.M., A.K.G., A.G.T.).

^* To whom correspondence should be addressed. E-mail: jwsturm{at}doh.health.nsw.gov.au.

Background and Purpose--Handicap, although more relevant to the patient than impairment or disability, has received little attention in people with stroke. The aim of this study was to identify, in an unselected population, factors determining handicap at 2 years after stroke.

Methods--All first-ever cases of stroke in a population of 306 631 over a 1-year period were assessed. Stroke severity, comorbidity, and demographic information was recorded. Among survivors, 2-year poststroke handicap was assessed with the London Handicap Scale. Disability, physical impairment, depression, anxiety, living arrangements, and recurrent stroke at 2 years were documented. If necessary, proxy assessments were obtained, except for mood. Linear regression analyses were performed to identify factors independently associated with handicap. First, all assessments (proxy and nonproxy) were examined; then, the nonproxy assessments were used to examine the effects of mood.

Results--Of 266 patients with incident stroke who were alive at 2 years, 226 (85%) were assessed. Significant determinants of handicap on univariable analysis were age, female sex, socioeconomic status, alcohol intake, stroke subtype, initial stroke severity; 2-year physical impairment, disability, depression and anxiety scores; institutionalization; and recurrent stroke. On multivariable analysis, the independent determinants of handicap were age and 2-year physical impairment and disability. In analysis restricted to nonproxy data, depression and anxiety were also independently associated with handicap.

Conclusions--Age, concurrent disability, and physical impairment were more important determinants of handicap than other demographic factors or initial stroke severity. Because depression and anxiety were independently associated with handicap, their treatment may potentially reduce handicap in stroke patients.

Key words: cerebrovascular disorders • health status • outcome assessment • quality of life

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