Reliability of the Modified Rankin Scale

Quinn, Terence J.; Dawson, Jesse; Walters, Matthew; Lees, Kennedy R.

doi:10.1161/strokeaha.109.557256

Cited by 444 publications

(312 citation statements)

References 15 publications

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“…A recent review demonstrated moderate to strong inter-and intraobserver reliability of the mRS, with weighted kappa coefficients of 0.90 and 0.94, respectively. 27 Therefore, individual variations in scoring are unlikely to account for the frequency of delayed improvement found in our study. Additionally, because the number of patients with improved mRS scores at 1 year and 3 years was more than twice the number of patients with worse mRS scores at these same time points, interand intrarater variability is unlikely to account for our findings.…”

Section: Figmentioning

confidence: 70%

Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design

Wilson¹,

Nakaji²,

Albuquerque³

et al. 2013

JNS

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Object Data regarding the time course of recovery after poor-grade subarachnoid hemorrhage (SAH) is lacking. Most SAH studies assess outcome at a single time point, often as early as 3 or 6 months following SAH. The authors hypothesized that recovery following poor-grade SAH is a dynamic process and that early outcomes may not always approximate long-term outcomes. To test this hypothesis, they analyzed long-term outcome data from a cohort of patients with poor-grade aneurysmal SAH to determine the incidence and predictors of early and delayed neurological improvement. Methods The authors reviewed outcome data from 88 poor-grade SAH patients enrolled in a prospective SAH treatment trial (the Barrow Ruptured Aneurysm Trial). They assessed modified Rankin Scale (mRS) scores at discharge, 6 months, 12 months, and 36 months after treatment to determine the incidence and predictors of neurological improvement during each interval. Results The mean aggregate mRS scores at 6 months (3.31 ± 2.1), 12 months (3.28 ± 2.2), and 36 months (3.17 ± 2.3) improved significantly compared with the mean score at hospital discharge (4.33 ± 1.3, p < 0.001), but they did not differ significantly among themselves. Between discharge and 6 months, 61% of patients improved on the mRS. The incidence of improvement between 6–12 months and 12–36 months was 18% and 19%, respectively. Hunt and Hess Grade IV versus V (OR 6.20, 95% CI 2.11–18.25, p < 0.001) and the absence of large (> 4 cm) (OR 2.76, 95% CI 1.02–7.55, p = 0.05) or eloquent (OR 5.17, 95% CI 1.89–14.10, p < 0.01) stroke were associated with improvement up to 6 months. Age ≤ 65 years (OR 5.56, 95% CI 1.17–26.42, p = 0.02), Hunt and Hess Grade IV versus V (OR 4.17, 95% CI 1.10–15.85, p = 0.03), and absence of a large (OR 8.97, 95% CI 2.65–30.40, p < 0.001) or eloquent (OR 4.54, 95% CI 1.46–14.08, p = 0.01) stroke were associated with improvement beyond 6 months. Improvement beyond 1 year was most strongly predicted by the absence of a large stroke (OR 7.62, 95% CI 1.55–37.30, p < 0.01). Conclusions A substantial minority of poor-grade SAH patients will experience delayed recovery beyond the point at which most studies assess outcome. Younger patients, those presenting in better clinical condition, and those without CT evidence of large or eloquent stroke demonstrated the highest capacity for delayed recovery.

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Section: Figmentioning

confidence: 70%

Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design

Wilson¹,

Nakaji²,

Albuquerque³

et al. 2013

JNS

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“…Imprecision in estimates of the treatment effect may have arisen from interobserver variability in determining the scores on the modified Rankin scale, 15,25 which was administered principally by telephone. Analysis of the net change in functional outcome was based on equal weights assigned to each score (0 through 6) on the modified Rankin scale, but patient and provider assessments can vary across health transitions, 26 and functional recovery can continue beyond 90 days.…”

Section: Low-dose Alteplase Bettermentioning

confidence: 99%

Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke

et al. 2016

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BACKGROUNDThrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve recovery along with a reduced risk of intracerebral hemorrhage. METHODSUsing a 2-by-2 quasi-factorial open-label design, we randomly assigned 3310 patients who were eligible for thrombolytic therapy (median age, 67 years; 63% Asian) to lowdose intravenous alteplase (0.6 mg per kilogram of body weight) or the standard dose (0.9 mg per kilogram); patients underwent randomization within 4.5 hours after the onset of stroke. The primary objective was to determine whether the low dose would be noninferior to the standard dose with respect to the primary outcome of death or disability at 90 days, which was defined by scores of 2 to 6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]). Secondary objectives were to determine whether the low dose would be superior to the standard dose with respect to centrally adjudicated symptomatic intracerebral hemorrhage and whether the low dose would be noninferior in an ordinal analysis of modified Rankin scale scores (testing for an improvement in the distribution of scores). The trial included 935 patients who were also randomly assigned to intensive or guideline-recommended blood-pressure control. RESULTSThe primary outcome occurred in 855 of 1607 participants (53.2%) in the low-dose group and in 817 of 1599 participants (51.1%) in the standard-dose group (odds ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; the upper boundary exceeded the noninferiority margin of 1.14; P = 0.51 for noninferiority). Low-dose alteplase was noninferior in the ordinal analysis of modified Rankin scale scores (unadjusted common odds ratio, 1.00; 95% CI, 0.89 to 1.13; P = 0.04 for noninferiority). Major symptomatic intracerebral hemorrhage occurred in 1.0% of the participants in the low-dose group and in 2.1% of the participants in the standard-dose group (P = 0.01); fatal events occurred within 7 days in 0.5% and 1.5%, respectively (P = 0.01). Mortality at 90 days did not differ significantly between the two groups (8.5% and 10.3%, respectively; P = 0.07). CONCLUSIONSThis trial involving predominantly Asian patients with acute ischemic stroke did not show the noninferiority of low-dose alteplase to standard-dose alteplase with respect to death and disability at 90 days. There were significantly fewer symptomatic intracerebral hemorrhages with low-dose alteplase.

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“…A primary limitation of SIS concerns feasibility and acceptability. Other commonly used scales in stroke are limited by imperfect reliability (mRS), floor and ceiling effects (BI), and poor validity for certain stroke syndromes (NIHSS) 21, 22, 23. The context of testing is also important.…”

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of a Modified Short Form of the Stroke Impact Scale

MacIsaac

Ali

Peters

et al. 2016

JAHA

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BackgroundThe Stroke Impact Scale (SIS) is a stroke‐specific, quality of life measure recommended for research and clinical practice. Completion rates are suboptimal and could relate to test burden. We derived and validated a short form SIS (SF‐SIS).Methods and ResultsWe examined data from the Virtual International Stroke Trial Archive, generating derivation and validation populations. We derived an SF‐SIS by selecting 1 item per domain of SIS, choosing items most highly correlated with total domain score. Our validation described agreement of SF‐SIS with original SIS and the SIS‐16 and correlation with Barthel Index, modified Rankin Scale, National Institutes of Health Stroke Scale, and Euro‐QoL 5 dimensions visual analog scales. We assessed discriminative validity (associations between SF‐SIS and factors known to influence outcome [age, physiological parameters, and comorbidity]). We assessed face validity and acceptability by sharing the SF‐SIS with a focus group of stroke survivors and multidisciplinary stroke healthcare staff. From 5549 acute study patients (mean age 68.5 [SD 13] years, mean SIS 64 [SD 32]) and 332 rehabilitation patients (mean age 65.7 [SD 11] years, mean SIS 61 [SD 11]), we derived an 8‐item SF‐SIS that demonstrated good agreement with original SIS and good correlation with our chosen functional and quality of life measures (all ρ>0.70, P<0.0001). Significant associations were seen with our chosen predictors of stroke outcome in the acute group (P<0.0001). The focus group agreed with the choice of items for SF‐SIS across 7 of 8 domains. ConclusionsUsing multiple, complementary methods, we have derived an SF‐SIS and demonstrated content, convergent, and discriminant validity. This shortened SIS should allow collection of robust quality of life data with less associated test burden.

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Reliability of the Modified Rankin Scale

Cited by 444 publications

References 15 publications

Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design

Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design

Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke

Derivation and Validation of a Modified Short Form of the Stroke Impact Scale

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