Handicap after stroke: how does it relate to disability, perception of recovery, and stroke subtype?: the north North East Melbourne Stroke Incidence Study (NEMESIS).
OBJECTIVE
Knowledge of patterns of handicap after stroke and of the relationship among handicap, disability, perception of recovery, and stroke subtype is limited. The aim of this study was to assess handicap 3 and 12 months after first-ever stroke in a community-based study.


METHODS
All strokes occurring in a population of 133 816 people were found and assessed. Patients were classified as having cerebral infarction (CI) or intracerebral hemorrhage (ICH) according to imaging or autopsy findings. Cases of CI were categorized using the Oxfordshire stroke classification. Handicap, disability, and perception of recovery were assessed 3 and 12 months after stroke using the London Handicap Scale, Barthel Index, and the question "Have you made a complete recovery from your stroke?" The association between disability and handicap was examined using Pearson's correlation. Differences in handicap among subtypes of CI were evaluated using one-way ANOVA.


RESULTS
There were 264 cases of CI or ICH. Of surviving patients, 113 (59%) were assessed at 3 months and 107 (64%) at 12 months. The domains of handicap most affected were physical independence and occupation. Only half the variance in handicap was due to disability. Of patients without disability, those who claimed complete recovery were less handicapped than those who claimed incomplete recovery. Patients with total anterior circulation infarction were more handicapped at 3 and 12 months than those with other subtypes of CI.


CONCLUSIONS
Stroke patients were handicapped across many domains. Handicap is only partly explained by disability. Stroke subtype should be considered in the interpretation of outcome data.
Sturm
Jonathan W
JW
National Stroke Research Institute and Department of Neurology, Austin & Repatriation Medical Centre, West Heidelberg, Victoria 3081, Australia. jsturm@austin.unimelb.edu.au
Dewey
Helen M
HM
Donnan
Geoffrey A
GA
Macdonell
Richard A L
RA
McNeil
John J
JJ
Thrift
Amanda G
AG
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001315:Australia / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification* / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D015996:Survival Rate; D016896:Treatment Outcome