Simplified Modified Rankin Scale Questionnaire

Bruno, Askiel; Akinwuntan, Abiodun Emmanuel; Lin, Chen; Close, Brian; Davis, Kristin; Baute, Vanessa; Aryal, Tia; Brooks, Desiree D.; Hess, David C.; Switzer, Jeffrey A.; Nichols, Fenwick T.

doi:10.1161/strokeaha.111.613273

Cited by 262 publications

(140 citation statements)

References 17 publications

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“…Follow-up data were collected at 7 days (or at hospital discharge, if it occurred before 7 days), unless death occurred earlier; data included final diagnosis, repeat NIHSS scores, and assessment of disability on the modified Rankin scale (a measure of disability in which scores range from 0 to 6, with 0 indicating no symptoms at all; 1, no clinically significant disability despite symptoms; 2, slight disability; 3, moderate disability requiring some help; 4, moderately severe disability requiring assistance with daily living; 5, severe disability, bed-bound, and incontinent; and 6, death). 17,18 Trained staff, who were unaware of the randomized intervention, contacted patients by telephone for the 90-day assessment using the simplified version of the modified Rankin scale, 19,20 which requires only "yes" or "no" answers to structured questions. The European Quality of Life Group 5-Dimension Self-Report Questionnaire (EQ-5D) 21 was also used to assess quality of life with respect to mobility, self-care, usual activities, pain or discomfort, and anxiety or depression (scores range from 1 to 3, with 1 indicating no problems, 2 some or moderate problems, and 3 severe problems).…”

Section: Data Collectionmentioning

confidence: 99%

Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke

et al. 2017

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BACKGROUNDThe role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. METHODSIn a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death). RESULTSThe median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P<0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P = 0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P = 0.83). There were no significant betweengroup differences in the rates of serious adverse events, including pneumonia. CONCLUSIONSDisability outcomes after acute stroke did not differ significantly between patients assigned to a lying-flat position for 24 hours and patients assigned to a sitting-up position with the head elevated to at least 30 degrees for 24 hours. (Funded by the

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Section: Data Collectionmentioning

confidence: 99%

Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke

et al. 2017

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“…The modified Rankin Scale (mRS) was assessed at 90 days by a stroke-trained physician or stroke study nurse certified in mRS via in-person or phone interview. 12,13 We adhere to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines (http://www.strobe-statement.org).…”

Section: Study Populationmentioning

confidence: 99%

Leukoaraiosis Burden Significantly Modulates the Association Between Infarct Volume and National Institutes of Health Stroke Scale in Ischemic Stroke

Helenius

Henninger

2015

Stroke

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Background and Purpose-The National Institutes of Health Stroke Scale (NIHSS) provides a reliable, quantitative measure of ischemic stroke severity and is predicted by the infarct size. We sought to determine whether leukoaraiosis severity affects the association between infarct size and NIHSS. Methods-NIHSS and diffusion-weighted imaging-defined infarct volumes from 312 prospectively enrolled patients with supratentorial, ischemic strokes were analyzed. Leukoaraiosis severity was graded according to the Fazekas scale and conceptually defined as absent (0; n=44), mild (1-2; n=106), moderate (3-4; n=105), and severe (5-6; n=57). ANCOVA was used to describe the effect of leukoaraiosis on the association between infarct volume and NIHSS. Multivariable linear regression models were constructed to assess whether the association of leukoaraiosis and infarct volume on NIHSS was independent of other clinically relevant covariates.

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“…The mRS was prospectively recorded at 14 days or discharge, 28 days, and 3 months after ICH symptom onset with a validated questionnaire (23,24). The mRS is valid when assessed by telephone or by proxy (25). Interviewers were unaware of delirium status.…”

Section: Outcome Assessmentmentioning

confidence: 99%

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Naidech

Beaumont²,

Rosenberg³

et al. 2013

Am J Respir Crit Care Med

100

105

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Rationale: The prognostic significance of delirium symptoms in intensive care unit (ICU) patients with focal neurologic injury is unclear. Objectives: To determine the relationship between delirium symptoms and subsequent functional outcomes and quality of life (QOL) after intracerebral hemorrhage. Methods: We prospectively enrolled 114 patients. Delirium symptoms were routinely assessed twice daily using the Confusion Assessment Method for the ICU by trained nurses. Functional outcomes were recorded with modified Rankin Scale (scored from 0 [no symptoms] to 6 [dead]), and QOL outcomes with Neuro-QOL at 28 days, 3 months, and 12 months. Measurements and Main Results: Thirty-one (27%) patients had delirium symptoms ("ever delirious"), 67 (59%) were never delirious, and the remainder (14%) had persistent coma. Delirium symptoms were nearly always hypoactive, were detected mean 6 days after intracerebral hemorrhage presentation, and were associated with longer ICU length of stay (mean 3.5 d longer in ever vs. never delirious patients; 95% confidence interval, 1.5-8.3; P ¼ 0.004) after correction for age, admit National Institutes of Health (NIH) Stroke Scale, and any benzodiazepine exposure. Delirium symptoms were associated with increased odds of poor outcome at 28 days (odds ratio, 8.7; 95% confidence interval, 1.4-52.5; P ¼ 0.018) after correction for admission NIH Stroke Scale and age, and with worse QOL in the domains of applied cognition-executive function and fatigue after correcting for the NIH Stroke Scale, age, benzodiazepine exposure, and time of follow-up. Conclusions: After focal neurologic injury, delirium symptoms were common despite low rates of infection and sedation exposure, and were predictive of subsequent worse functional outcomes and lower QOL. Keywords: delirium; outcomes; quality of lifeThe symptoms of delirium, a potential consequence of multiple clinical disease states and physiologic aberrations, include a shift in baseline mental status, inattention, and disorganized thinking or altered level of consciousness. Although nonspecific, this syndrome is an independent predictor of higher mortality (1), longer length of stay (LOS), higher cost of care, and worse long-term cognitive outcomes in medical, surgical, burn, and trauma intensive care unit (ICU) patients (2). There are few such data, however, in ICU patients with focal neurologic injury without systemic illness.Risk factors for delirium symptoms are typically global (infection [3] and intravenous sedation, particularly benzodiazepines [BZDs]) (4, 5) as opposed to focal lesions (e.g., hematoma). Most mechanically ventilated patients are delirious during hospitalization (1), potentially because of the sedation regimen (e.g., BZD infusion), but sedation is typically minimized in neurologically injured patients to permit repeated neurologic assessment that may lead to an acute intervention (6).Screening tests for delirium have been recently validated in neurologically ill patients (7-9), including ischemic stroke (7, 10) and intracerebra...

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Simplified Modified Rankin Scale Questionnaire

Cited by 262 publications

References 17 publications

Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke

Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke

Leukoaraiosis Burden Significantly Modulates the Association Between Infarct Volume and National Institutes of Health Stroke Scale in Ischemic Stroke

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

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