Cross-cultural validation of the London Handicap Scale and comparison of handicap perception between Chinese and UK populations.

Objective: To validate the London Handicap Scale on populations from diverse cultures by comparing handicap perceptions in Mainland (Sichuan) Chinese, Hong Kong Chinese and UK subjects.

Method: Utility ratings of 10 real life health scenarios were given by a group of healthy and disabled Sichuan Chinese subjects. The ratings were then correlated with published scale scores of HK and UK subjects on the same scenarios.

Setting: A university for older persons in Sichuan and the 4th Hospital of Sichuan University.

Subjects: Two hundred and one Sichuan Chinese (mean age: 63.3 years) comprising of healthy (31.8%) and disabled individuals with stroke, fracture, cancer or other chronic conditions (69.2%) were recruited in the study.

Results: Overall ratings for health scenarios were found to be highly correlated between Sichuan Chinese and UK subjects (r = 0.85; P < 0.0005), and between Sichuan and HK Chinese subjects (r = 0.98; P < 0.0005), with the exception of scenario J. Interesting differences in valuation were also observed between Sichuan subgroups in three scenarios. Self-perceived health status of the Sichuan Chinese can be accurately reflected by the severity of their handicap as measured by the London Handicap Scale LHS (r = -0.39, P = 0.000). For Sichuan Chinese, the economic domain of handicap was rated with poorer scores compared with the other domains.

Conclusion: The international notion of handicap, or limitation in participation, applies across different cultures and is also valid in mainland Chinese. UK, HK, and Sichuan subjects share similar perception on selected handicap scenarios. The London Handicap Scale is useful for health evaluation and outcome assessment for elderly of different cultures.