Modified Rankin Scale
Original Editor - Mmesoma Eyisi
Top Contributors - Mmesoma Eyisi
Introduction
The Modified Rankin Scale (mRS) which was originally the Rankin Scale developed by Dr. John Rankin in 1957,[1] and was modified to the Modified Rankin Scale by Charles Warlow and others as part of the UK-TIA (United Kingdom Transient Ischaemic Attack) trial in the 1980s.[2] The mRS is a 6-level ordinal categorical scale outcome measure used primarily to classify the degree of disability in stroke patients.[3] It is the most common functional outcome measure in contemporary stroke research.[4]
Objective
The mRS is the most prevalent outcome measure that assesses the degree of disability or dependence in performing the activities of daily living (ADL) in stroke patients.[3]
Method of Use
The mRS has 6 levels with 0 - 6 scores that assess the neurological disease's function level.[5]
Where:
| Grade | mRS |
|---|---|
| 0 | No symptoms at all |
| 1 | No significant disability: despite symptoms, able to carry out all usual duties and activities |
| 2 | Slight disability: unable to perform all previous activities but able to look after own affairs without assistance |
| 3 | Moderate disability: requiring some help but able to walk without assistance |
| 4 | Moderately severe disability: unable to walk without assistance and attend to own bodily needs without assistance |
| 5 | Severe disability: bedridden, incontinence, and requiring constant nursing care and attention |
| 6 | Death |
How To Use
The mRS assessment typically involves a guided interview. Patients are asked about their activities of daily living (ADL), including those performed outdoors during this process. The assessment also includes evaluating neurological impairments, such as aphasia and cognitive deficits. To determine the patient's MRS grade, all aspects of their physical and mental abilities, as well as their speech are taken into account.[6]
Evidence
Reliability: The mRS is a reliable instrument used to classify the disability of stroke. Its overall reliability is moderate. with room for improvement. It is greatly improved by including the grade of mRS 6 (death) in clinical trials. The mRS has excellent inter-observer reliability but varies with structured interviews which shows potential benefits, but inconsistent effects.[7] The Intra-observer reliability is excellent but may be influenced by recall bias and functional changes over time.[8] However, there need for standardized training and assessment methodologies. [7]
Validity: The validity of the mRS has been affirmed by multiple studies in which it has been consistently observed that the location, type, and extent of stroke injury are closely related to short and longer-term disability. People with more severe strokes tend to have higher mRS scores (more disability). Improvements in brain function after treatment match improvements in mRS scores. Also, mRS scores align with scores from other disability scales (like the Barthel Index or Functional Independence Measure) which confirms that the mRS is a reliable tool for measuring stroke-related disability.[9]
References
- ↑ Quinn TJ, Dawson J, Walters M. Dr John Rankin; his life, legacy and the 50th anniversary of the Rankin Stroke Scale. Scottish medical journal. 2008 Feb;53(1):44-7.
- ↑ Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. Journal of Neurology, Neurosurgery & Psychiatry. 1991 Dec 1;54(12):1044-54.
- ↑ 3.0 3.1 Biester RC. Chapter 12: Outcome Scales and Neuropsychological Outcome. In: Monitoring in Neurocritical Care. Philadelphia, PA: W.B. Saunders; 2013. p. 107-113.e2.
- ↑ Quinn TJ, Dawson J, Walters MR, Lees KR. Functional outcome measures in contemporary stroke trials. International Journal of Stroke [Internet]. 2009 [cited [date]]; 4(3): 200-206.
- ↑ Patel N, Rao VA, Heilman-Espinoza ER, Lai R, Quesada RA, Flint AC. Simple and reliable determination of the Modified Rankin Scale score in neurosurgical and neurological patients: the mRS-9Q. Neurosurgery 2012 Nov;71(5):971-975. DOI: 10.1227/NEU.0b013e31826a8a56.
- ↑ Zeltzer L, Korner-Bitensky N, Sitcoff E, Figueiredo S. Modified Rankin Scale (MRS). Stroke Engine. Evidence reviewed as of 2008 Aug 19.
- ↑ 7.0 7.1 Terence J. Quinn, MRCP, Jesse Dawson, MRCP, Matthew R. Walters, MD, Kennedy R. Lees, MD. Reliability of the Modified Rankin Scale: A Systematic Review. Stroke 2009 Aug;40(10)
- ↑ 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(5): 777-781.
- ↑ 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 Mar 1;38(3):1091-6.