Makindo Medical Notes

Related Subjects: |Acute Stroke Assessment (ROSIER&NIHSS) |Causes of Stroke

Introduction

The Modified Oxford Handicap Scale (MOHS) is a simple clinical tool used to assess the degree of disability and dependence in daily life following a stroke or other neurological illness. It is a streamlined version of the Oxford Handicap Scale, designed for quick use at the bedside or in trials. The scale ranges from 0 to 5, with higher scores = greater disability.

📊 Scale Description

• 🟢 0 – No symptoms: Fully independent, no neurological symptoms.
• 🟡 1 – Minor symptoms: Able to perform all activities and duties; mild residual symptoms only.
• 🟠 2 – Some restriction: Mild disability; lifestyle and activities slightly limited but no help needed for personal care.
• 🟤 3 – Dependent: Needs some help with complex tasks; can walk unassisted and manage basic personal needs.
• 🔴 4 – Fully dependent: Needs assistance for personal care and cannot walk alone; dependent on others for daily living.
• ⚫ 5 – Death: Patient has died.

🔎 Interpretation

• 🟢 0–1: No significant disability → full independence.
• 🟠 2: Mild disability but independent in self-care.
• 🟤 3: Moderate disability → some assistance required, but not fully dependent.
• 🔴 4: Severe disability → full dependence for care.
• ⚫ 5: Death.

⚕️ Clinical Use

• 📈 Outcome measurement: Widely used in stroke trials and follow-up to quantify recovery or disability.
• 🧑‍⚕️ Treatment planning: Guides decisions about rehabilitation, community support, or institutional care.
• 🔮 Prognostic value: Higher scores = poorer prognosis, greater care needs.
• 💬 Communication: Provides a standardised “common language” for describing patient disability across the MDT.

🆚 Comparison with Other Scales

The MOHS is similar to the Modified Rankin Scale (mRS), but offers a more straightforward 0–5 structure. Both measure functional independence, but MOHS is simpler and quicker, making it practical in busy clinical and research settings.

📚 References

• van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604-7.
• Wade DT, Hewer RL. Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry. 1987;50(2):177-82.
• Duncan PW, Jorgensen HS, Wade DT. Outcome measures in acute stroke trials: a systematic review. Stroke. 2000;31(6):1429-38.