Two simple questions to assess outcome after stroke: a European study.
OBJECTIVE
The "2 simple questions" were designed as an efficient way of measuring outcome after stroke. We assessed the sensitivity and specificity of this tool, adapted for use in 8 European centers, and used it to compare outcomes across centers.


METHODS
Data were taken from the Biomed II prospective study of stroke care and outcomes. Three-month poststroke data from 8 European centers were analyzed. Sensitivity and specificity were assessed by comparing responses to the 2 simple questions with Barthel Index and modified Rankin scale scores. Adjusting for case mix, logistic regression was used to compare patients in each center with "good" outcome (not dependent and fully recovered) at 3 months.


RESULTS
Data for 793 patients were analyzed. For the total sample, the dependency question had a sensitivity of 88% and a specificity of 77%; the recovery question had a sensitivity of 78% and a specificity of 90%. Dependency data from Riga had much lower sensitivity. There was variation in good outcome between centers (P:=0.0015). Compared with the reference center (Kaunas), patients in Dijon, Florence, and Menorca were more likely to have good outcome, after adjusting for case mix.


CONCLUSIONS
Dependency and recovery questions showed generally high sensitivity and specificity. There were significant differences across centers in outcome, but reasons for these are unclear. Such differences raise particular questions about how patients interpreted and answered the simple questions and the extent to which expectations of recovery and perceived needs for assistance vary cross-culturally.
Department of Public Health Sciences, Guy's King's and St Thomas' School of Medicine, King's College London (UK). christopher.mckevitt@kcl.ac.uk
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D000203:Activities of Daily Living; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards*; D020127:Recovery of Function; D015203:Reproducibility of Results; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires / Q000592:standards*