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Modified Rankin Scale for Neurologic Disability

Calculators  Neurology
Modified Rankin Scale is generally used to determine the grade of disability in the day to day activities of patient who have suffered stroke or other causes of neurological disability.
Patient's Baseline Activity
Choose best fit of patient's ability
No symptoms at all 0
No significant disability despite symptoms; able to carry out all usual duties and activities 1
Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance 2
Moderate disability; requiring some help, but able to walk without assistance 3
Moderately severe disability; unable to walk and attend to bodily needs without assistance 4
Severe disability; bedridden, incontinent and requiring constant nursing care and attention 5
Dead 6
Result:

Background

Measured Factor
Patient's baseline activity
Measured Factor Disease
  • Stroke and other causes of neurological disorders
Measured Factor Detail
Modified rankin scale estimates neurological disability in patients who have suffered stroke based on the dependency or difficulty in performing daily activities. This scale is commonly used clinically in clinical trials for stroke disease.
Speciality
Neurologist
Body System
Neurology
Measured Factor Low Impact
  • 0 point indicates that there is no neurological disability in individual.
Measured Factor High Impact
  • If the score comes 6 then the patient is considered to be dead

Result Interpretation

Ranges Ranges
  • Critical High: 600%
  • Normal: 0
  • Normal Adult Male: 0%
  • Normal Adult Female: 0%
  • Normal Pediatric: 0
  • Normal Neonate Female: 0
  • Normal Geriatric Male: 0%
  • Normal Geriatric Female: 0%
Result High Conditions
  • Mortality
Test Limitations
There remains uncertainty regarding mRS reliability as  interobserver variability is observed in various studies
References: 2

Studies

Study Validation 1
This study aimed to put together and systematically determine the properties of the modified Rankin scale (mRS) in measuring global disability in stroke patients. Various articles were searched that provided the data on the structure, validation, scoring, and psychometric properties of the mRS and its use in clinical trials and this selection was based on relevance, study design and use of appropriate statistical methods. A total 50 articles were selected for further evaluation. Data from the articles showed the construct validity of the mRS by its relationships to physiological variables like stroke type, lesion size, perfusion and neurological impairment. Inter-rater reliability with mRS was seen moderate Also, recent evaluation showed that the sample size of stroke patients in randomized clinical trials of acute stroke treatment should be small if mRS is used as primary end point. This study concluded that validity and reliability of mRS has been well reported in several studies and this tool is efficient in predicting the impact of new 
stroke treatments.
References: 3
Study Validation 2
The purpose of this study was to determine the variation in assessing functional outcomes using the modified Rankin Scale (mRS) and investigating its better approach i.e. mRS-structured interview (mRS-SI). A total of 113 patients were involved in the study and both mRS and mRS-SI was analyzed in these patients. Results showed overall agreement of mRS was 43% when compared with structured interview overall agreement was 81%. Reproducibility for both the approaches was good. This study concluded that with addition of structured interview overall agreement between raters gets improved in assessing global outcome after stroke.
References: 4
Study Validation 3
The aim of this retrospective  study was to validate the modified Rankin Scale (mRS) on three aspects pre-stroke disability; prognostic accuracy and correlation of pre-stroke mRS scores with process of care. Data from 2,491 patients with stroke were collected and analyzed. Results showed with every point increase of mRS pre-stroke the outcomes of prognostic variables gets worsen (unadjusted p < 0.001). A difference was found between pre-stroke mRS and treatment therapy, with greater pre-stroke mRS patient more likely to receive evidence-based care. This study concluded that there mRS is strong predictor of prognosis but not association was there between treatment and pre mRS score.
References: 5
Study Additional 1
The aim of the systematic review was to determine the modified Rankin Scale for interobserver variability. For this 2 researchers independently reviewed the literature across various platforms. After analyzing 10 studies with 587 patients they found the Reliability of modified Rankin Scale differ from weighted kappa=0.95 to kappa=0.25 and Overall reliability of mRS was kappa=0.46; weighted kappa=0.90 (traditional modified Rankin Scale) and kappa=0.62; weighted kappa=0.87 (structured interview). This review highlighted about the weakness of mRS by showing uncertainty of modified Rankin Scale reliability. More studies needs to done to make this tool more reliable.
References: 6
Study Additional 2
This study investigated the performance of simplified mRS questionnaire (smRSq) which is a new tool similar to conventional mRS. A total of 50 patients with stroke (minimum one incident) were involved in the study and reliability of smRSq was evaluated. Results showed agreement among the raters was 78% with kappa statistic value of 0.72 and the weighted kappa(w) was 0.82. This study concluded that smRSq appeared to had very good reliability likewise of structured interview mRS but with less time consumption.
References: 2

References

  1. 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.
  2. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009;40(10):3393-5.
  3. Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091-6.
  4. Wilson JT, Hareendran A, Hendry A, Potter J, Bone I, Muir KW. Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke. 2005;36(4):777-81.
  5. Quinn TJ, Taylor-rowan M, Coyte A, Clark AB, Musgrave SD, Metcalf AK, et al. Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment. Front Neurol. 2017;8:275.
  6. Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, et al. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke. 2002;33(9):2243-6.