A Comparison ofFiveStroke Scales With Measures ofDisability, Handicap, andQuality ofLife

Background andPurpose: Recently muchdebate hasarisen on theappropriateness ofassessing stroke outcomes withstroke impairment scales. Ourpurposewas tostudy therelationship between long-term impairments andfunctional outcomes intermsofdisability, handicap, andquality oflife. Methods: We studied 87patients whohada stroke 6monthsearlier. Impairments werescored on five stroke scales: theOrgogozo Scale, theNational Institutes ofHealthscale, theCanadianNeurological Scale, theMathewscale, andtheScandinavian Stroke Scale. Disability was assessed withtheBarthel Index, handicap withtheRankinscale, andquality oflife withtheSickness Impact Profile. Thelinear relationship between stroke scales andfunctional scales was assessed withcorrelation coefficients. We usedregression analyses toexplain functional health. Results: Thestroke scales were highly related toone another (range, r= -.85to.92). Thecorrelation between stroke scales andfunctional scales was <.70anddecreased fromBarthel (meanr2=47.5%) to Rankin(meanr2=36.5%) toSickness Impact Profile (meanr2=33%). Stroke scales were rather poorly correlated withpatients' psychosocial conditions (meanr2=11.5%). Functional health status was mainly related toleg powerandorientation. Thestandardized stroke scale weights oftheexplanatory items were lower thantheir standardized regression weights. Conclusions: Strokescales onlypartly explain functional health. Theimpactofimpairments on functional outcomes seemstobeunderestimated bythe stroke scale weights. Thecorrelation patterns give empirical support tothehierarchical structure oftheInternational Classification ofImpairments, Disabilities andHandicaps. (Stroke 1993;24:1178-1181)