Tracking stroke effects, the modified rankin scale

Would you believe the main change was to add grade O. This scale is a valuable resource: - not for the individuals tested but to track historical trends of stroke disabilities. For this I won’t use it for a protest I have in mind.

The modified Rankin scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It has become the most widely used clinical outcome measure for stroke clinical trials.

The scale was originally introduced in 1957 by Dr. John Rankin of Stobhill Hospital, Glasgow, Scotland, and then modified to its currently accepted form by Prof. C. Warlow’s group at Western General Hospital in Edinburgh for use in the UK-TIA study in the late 1980’s. The modified version differs from Rankin’s original scale mainly in the addition of grade 0, indicating a lack of symptoms. The first publication of the current modified Rankin Scale was in 1988 by van Swieten, et al, who also published the first interobserver agreement analysis of the modifies Rankin Scale.

Interobserver reliability of the mRS can be improved by using a structured questionnaire during the interview process and by having raters undergo a multimedia training process. The multimedia mRS training system which was developed by Prof. K. Lees’ group at the University of Glasgow is available online. The mRS is frequently criticized for its subjective nature which is viewed as skewing results, but is used throughout hospital systems to assess rehabilitation needs and outpatient course. These criticisms were addressed by researches creating structured interviews which ask simple questions both the patient and/or the caregiver can respond to.

More recently, several tools have been developed to more systematically determine the mRS, including the mRSSI, the RFA, and the mRS-9Q. The mRS-9Q is in the public domain and a free web calculator is available at www.modifiedrankin.com.

The Modified Rankin Scale (mRS)

The scale runs from 0-6, running from perfect health without symptoms to death.

• 0 – No symptoms
• 1 – No significant disability. Able to carry out small usual activities, despite some symptoms.
• 2 – Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.
• 3 – Moderate disability. Requires some help, but able to walk unassisted.
• 4 – Moderately sever disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted.
• 5 – Sever disability. Requires constant nursing care and attention, bedridden, incontinent.
• 6 – Dead.

Angus