Quality of Life Research

, Volume 15, Issue 7, pp 1251–1256 | Cite as

Initial validation of the Swedish version of the London Handicap Scale

  • Albert Westergren
  • Peter Hagell


Objective: To adapt and evaluate the unweighted version of the London Handicap Scale (LHS) for use in Sweden. Materials & Methods: Respondent burden, linguistic validity and patient perceived relevance was assessed in 16 neurologically ill patients. Internal consistency reliability and construct validity were evaluated among 89 stroke survivors six months after discharge. Results: Patients perceived the LHS as relevant and easy to understand and complete. Mean time to complete the questionnaire was 10 min. Cronbach’s alpha reliability was 0.85. The LHS differentiated between patients living at home and in special accommodations. As expected, scores correlated strongly and weakly with indices of related and more remote constructs, respectively. There were no floor-, but large ceiling effects. Conclusions: The observations reported here are in accordance with previous studies using the original British LHS and provide initial support for the reliability and validity of the instrument for use in Sweden. However, ceiling effects may limit its usefulness as an outcome measure.


London Handicap Scale Outcome assessment Sweden Validation studies 



activities of daily living




Confidence interval


International Classification of Functioning, Disability and Health


International Classification of Impairment, Disability and Handicap


interquartile range


London Handicap Scale


mental component summary score


physical component summary score


standard deviation


12-item Short Form Health Survey


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  1. 1.
    (1980). International Classification of Impairments, Disabilities and Handicaps: A Manual of Classification Relating to the Consequences of Disease. World Health Organization, GenevaGoogle Scholar
  2. 2.
    (1994). Handicap one year after stroke: validity of a new scale. J Neurol Neurosurg Psychiatry 57: 825–829PubMedGoogle Scholar
  3. 3.
    (1994). Measuring handicap: motives, methods and a model. Qual Health Care 3: 53–57PubMedGoogle Scholar
  4. 4.
    (1994). Measuring handicap: the London Handicap Scale, a new outcome measure for chronic disease. Qual Health Care 3: 11–16PubMedCrossRefGoogle Scholar
  5. 5.
    (2002). International Classification of Functioning, Disability and Health. World Health Organization, GenevaGoogle Scholar
  6. 6.
    (2002). International classification of functioning, disability and health: an introduction and discussion of its potential impact on rehabilitation services and research. J Rehabil Med 34: 201–204PubMedCrossRefGoogle Scholar
  7. 7.
    (2003). Measuring participation according to the International Classfication of Functioning, Disability and Health (ICF). Disabil Rehabil 25: 577–587PubMedCrossRefGoogle Scholar
  8. 8.
    (2002). Team approach versus ad hoc health services for young people with physical disabilities: a retrospective cohort study. Lancet 360: 1280–1286PubMedCrossRefGoogle Scholar
  9. 9.
    (2005). How does stroke restrict participation in long-term post-stroke survivors?. Acta Neurol Scand 112: 157–162PubMedCrossRefGoogle Scholar
  10. 10.
    (2001). Cross-cultural validation of the London Handicap Scale in Hong Kong Chinese. Clin Rehab 15: 177–185CrossRefGoogle Scholar
  11. 11.
    Pajalic Z, Karlsson S, Westergren A. Functioning and subjective health among stroke survivors after discharge from hospital. J Adv Nurs; in pressGoogle Scholar
  12. 12.
    (1996). Longitudinal studies of dependence in daily life activities among elderly persons. Scand J Rehabil Med Suppl 34: 1–35PubMedGoogle Scholar
  13. 13.
    (2000). The London handicap scale: a re-evaluation of its validity using standard scoring and simple summation. J Neurol Neurosurg Psychiatry 68: 365–367PubMedCrossRefGoogle Scholar
  14. 14.
    (1996). A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34: 220–233PubMedCrossRefGoogle Scholar
  15. 15.
    (2004). Integrating patient-reported outcomes. Value Health 7: S9–S12PubMedCrossRefGoogle Scholar
  16. 16.
    (1995). Health Measurement Scales: A Practical Guide to their Development and Use. Oxford University Press, OxfordGoogle Scholar
  17. 17.
    (1997). Performance of a new, HIV/AIDS-targeted quality of life (HAT-QoL) instrument in asymptomatic seropostivie individuals. Qual Life Res 6: 561–571PubMedCrossRefGoogle Scholar
  18. 18.
    (1994). Individual-patient monitoring in clinical practice: are available health status surveys adequate?. Qual Life Res 4(4): 293–307CrossRefGoogle Scholar
  19. 19.
    (2000). Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 81: S15–S20PubMedCrossRefGoogle Scholar
  20. 20.
    (2001). Psychometric properties of the Impact on Participation and Autonomy Questionnaire. Arch Phys Med Rehabil 82: 210–216PubMedCrossRefGoogle Scholar
  21. 21.
    (1998). Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2: 1–74PubMedGoogle Scholar
  22. 22.
    (2002). Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11: 193–205CrossRefGoogle Scholar
  23. 23.
    (2003). Are the ICF activity and participation dimensions distinct?. J Rehabil Med 35: 145–149PubMedCrossRefGoogle Scholar
  24. 24.
    (2002). Quality of life measures after stroke. Uses and abuses of the SF-36. Stroke 33: 1348–1356PubMedCrossRefGoogle Scholar
  25. 25.
    (2004). Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale. Disabil Rehabil 26(6): 362–370PubMedCrossRefGoogle Scholar
  26. 26.
    (1996 Sep). Handicap in inflammatory arthritis. Br J Rheumatol 35(9): 891–897CrossRefGoogle Scholar
  27. 27.
    (2000). A comparison of the responsiveness of the Nottingham extended activities of daily living, London handicap scale and SF-36. Disabil Rehabil 22(17): 786–793PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  1. 1.Division of Gerontology and Caring Sciences, Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
  2. 2.The Vårdal Institute, the Swedish Institute for Health ScienceLund UniversityLundSweden
  3. 3.Department of Rehabilitation MedicineCentral Hospital Kristianstad, Northeast Skåne Health Care DistrictKristianstadSweden
  4. 4.Department of NeurologyUniversity HospitalLundSweden

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