CAN SIMPLE QUESTIONS ASSESS OUTCOME AFTER STROKE

We assessed the validity and reliability of simple questions to assess outcome after stroke in a group of 60 patients. 100 consecutive patients admitted to hospital with acute stroke were prospectively studied, and survivors were randomised to follow-up either by postal questionnaire or telephone interview. The responses to the postal or telephone assessment from the 60 patients who could participate in the study were compared to the Barthel Index (BI) and Oxford Handicap Scale (OHS) obtained from a face-to-face interview by a trained nurse (who was 'blind' to the postal or telephone responses), The response to the postal questionnaire or telephone interview item: 'In the last 2 weeks, did you require help from another person for everyday activities?', had an accuracy of 75% in identifying patients with bad outcome (defined by a BI <20/20) and an accuracy of 83% when bad outcome was defined by an OHS category of 3, 4 or 5. The answer to the item 'Do you feel that you have made a complete recovery from your stroke?' had an accuracy of 90% when compared with an OHS category of 0 obtained at the nurse interview. The responses to the simple 'dependency' and 'recovery' questions obtained by postal questionnaire and telephone interview agreed well with the responses to the same questions administered by the nurse (kappa = 0.62 and 0.73, respectively). There was no difference between outcome assessed by postal or telephone methods, and no clinically important difference between self- or carer-completed questionnaires. These results suggest that very simple measures of outcome after stroke can be developed. The two simple questions were practical, valid, reliable and could be administered effectively by post or telephone, without the need for a face-to-face interview; this method would therefore be suitable for all types of very large-scale studies of outcome after stroke (e.g. randomised trials, observational studies and multicentre audits of stroke care).