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Stroke, Vol 24, 1178-1181, Copyright © 1993 by American Heart Association
R De Haan, J Horn, M Limburg, J Van Der Meulen and P Bossuyt
BACKGROUND AND PURPOSE: Recently much debate has arisen on the
appropriateness of assessing stroke outcomes with stroke impairment scales.
Our purpose was to study the relationship between long-term impairments and
functional outcomes in terms of disability, handicap, and quality of life.
METHODS: We studied 87 patients who had a stroke 6 months earlier.
Impairments were scored on five stroke scales: the Orgogozo Scale, the
National Institutes of Health scale, the Canadian Neurological Scale, the
Mathew scale, and the Scandinavian Stroke Scale. Disability was assessed
with the Barthel Index, handicap with the Rankin scale, and quality of life
with the Sickness Impact Profile. The linear relationship between stroke
scales and functional scales was assessed with correlation coefficients. We
used regression analyses to explain functional health. RESULTS: The stroke
scales were highly related to one another (range, r = -.85 to .92). The
correlation between stroke scales and functional scales was < .70 and
decreased from Barthel (mean r2 = 47.5%) to Rankin (mean r2 = 36.5%) to
Sickness Impact Profile (mean r2 = 33%). Stroke scales were rather poorly
correlated with patients' psychosocial conditions (mean r2 = 11.5%).
Functional health status was mainly related to leg power and orientation.
The standardized stroke scale weights of the explanatory items were lower
than their standardized regression weights. CONCLUSIONS: Stroke scales only
partly explain functional health. The impact of impairments on functional
outcomes seems to be underestimated by the stroke scale weights. The
correlation patterns give empirical support to the hierarchical structure
of the International Classification of Impairments, Disabilities and
Handicaps.
ARTICLES
A comparison of five stroke scales with measures of disability, handicap, and quality of life
Department of Neurology, University of Amsterdam, The Netherlands.
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