THE RELATIONSHIP BETWEEN IMPAIRMENT AND FUNCTIONAL HEALTH SCALES IN THE OUTCOME OF STROKE

In an evaluation of the relationship between long-term neurological impairment and functional health aspects, neurological impairment was measured with four stroke scales and the results compared with disability, handicap, and quality-of-life measures. The explanatory ability of the stroke scales decreased with the hierarchical ordering of the functional health indices. Linear regression analysis also showed that the impact of the most important impairments on functional health is probably underestimated by their conventional item weights. In general, stroke scales could explain less than half of the variance of activities of daily living (ADL) scores and only a quarter of the variance in instrumental ADL scores. ADL disability was only explained by leg motor function, whereas hand and arm motor function were the primary explanatory factors of instrumental disability. The choice of health outcome measurements should relate to issues which are important to the patient. The ability to perform normal daily activities is a more important criterion than, say, leg muscle tone. Many functional health scales are available and may be more appropriate for measuring the patient's recovery than specific stroke scales which give a more limited and indirect measure of the overall outcome.