OBJECTIVES: We aimed to determine whether, and by how much, stroke severity, as measured by the Modified Rankin Scale (MRS) of disability, influences the duration of subsequent disability, and therefore the need for rehabilitation and nursing care. METHODS: A total of 7599 patients were enrolled in a randomised clinical trial (MATCH) of clopidogrel vs. aspirin + clopidogrel after a transient ischaemic attack or ischaemic stroke within 90 days (median 15 days). The two study arms were pooled. The Modified Rankin Scale (MRS) was assessed at: baseline (randomisation), months one, three, six, 12, 18 and following a recurrent stroke. RESULTS: At baseline, 20.7% of 7599 patients were disabled (11.6% at MRS 3, 8.6% at MRS 4 and 0.5% at MRS 5). Median time to change from disabled state (MRS 3, 4, or 5) to non-disabled state (MRS 0, 1, or 2) was three-months for patients with moderate disability (MRS 3) and 18 months for patients with severe disability (MRS 4). For patients with very severe disability (MRS 5), 80.7% remained disabled at 18-months. Among the 804 patients who experienced a recurrent ischaemic stroke during the study, 53.4% of patients were disabled after the recurrent stroke (20.3% at MRS 3, 20.8% at MRS 4, and 12.3% for MRS 5). Median time to change from disabled state to non-disabled state was six-months for MRS 3 and more than 18-months for MRS 4. For MRS 5, 94.5% of patients still remained disabled. CONCLUSIONS: More severe strokes and recurrent strokes cause longer-term disability. After a recurrent stroke, the median time to change from a disabled to non-disabled state is six-months for patients with moderate disability (MRS 3) and more than 18-months for patients with severe disability (MRS 4). Almost all patients with very severe disability (MRS 5), remain disabled and require permanent nursing care.