Background and Purpose-The modified Rankin Scale (mRS) is a popular primary stroke outcome measure, but its usefulness is limited by suboptimal reliability (inter-rater agreement). Methods-We developed and tested the reliability of a simplified mRS questionnaire (smRSq) in 50 patients after stroke seen in outpatient clinics. Randomly chosen paired raters administered the smRSq within 20 minutes of each other and the ratings were blinded until the end of this study. Results-Agreement among the raters was 78%, the statistic was 0.72 (95% CI, 0.58 -0.86), and the weighted w statistic taking into account the extent of disagreement was 0.82 (95% CI, 0.72-0.92). The average time to administer the smRSq was 1.67 minutes. Conclusions-The smRSq appears to have very good reliability that is similar to that of a structured interview mRS and is considerably less time-consuming. (Stroke. 2010;41:1048-1050.)Key Words: clinometrics Ⅲ modified Rankin Scale Ⅲ outcome assessment R eliability (consistency) of measurements is of paramount importance in scientific research. 1 The modified Rankin Scale (mRS) 2 is a popular primary outcome measure in acute stroke trials, but its usefulness is limited by suboptimal reliability (inter-rater agreement). There is considerable variability in the reported reliability of the mRS. 3 A structured interview mRS that takes Ϸ15 minutes to administer was developed to help improve the mRS reliability. 4 In a recent systematic review the overall agreement between mRS raters without a standardized rating approach was 71%, the kappa () statistic was 0.46 (95% CI, 0.41-0.51), and the weighted kappa ( w ) statistic, taking into account the extent of all disagreements, was 0.90 (95% CI, 0.86 -0.94). 3 Using the structured interview mRS, the overall agreement was Ϸ73%, was 0.62 (95% CI, 0.56 -0.69), and w was 0.87 (95% CI, 0.75-1.00). 3,5,6 Inter-rater agreement was significantly improved with the structured interview mRS among raters with varied professional backgrounds, 7 which simulates a multicenter clinical trial. In an effort to simplify, standardize, and increase further the reliability of the mRS, we developed a simplified mRS questionnaire (smRSq) and tested it among raters with varied professional experiences. Materials and MethodsFour stroke faculty members with a total of 63 years experience applying the traditional unstructured mRS jointly created the smRSq (Figure). Using the key issues distinguishing between consecutive mRS categories, we created relatively simple questions that could be answered "yes" or "no" by patients or caregivers with little or no explanation. The key mRS issues were having no residual symptoms (0), being able to resume all prestroke activities (Յ1), being able to live independently (Յ2), being able to walk without assistance (Յ3), and not requiring constant supervision (Յ4).We screened patients for this study consecutively in 4 weekly clinics staffed by the stroke specialists and in 2 weekly resident continuity clinics at the Medical College of Georgia. Eligibility f...

Background and Purpose-The simplified modified Rankin Scale questionnaire (smRSq) enables a reliable and rapid determination of the modified Rankin Scale score after stroke. We test the reliability and validity of a slightly revised smRSq. Methods-Fifty consecutive outpatients 4.83Ϯ3.00 months after stroke were scored with a slightly revised smRSq by 3 raters selected consecutively from a list of 10: 4 stroke faculty, 3 neurology residents, 2 medial students, and 1 stroke research coordinator. Two ratings were in person within 20 minutes of each other and 1 was by telephone 1 to 3 days later. The telephone rating also included a quality of life scale, the Short-Form-12v2. Each rater was blinded to the other raters' scores. Results-The

Background and Purpose-Acute stroke clinical trials are conducted primarily at academic medical centers. As a result, patients living in rural areas are excluded from participation, results may not be generalizable to nonacademic settings, and studies may be slow to recruit subjects. Telemedicine can provide rural patients with emergency neurovascular consultation. We sought to determine whether telemedicine facilitates enrollment into acute stroke trials. Methods-We have an established rural "hub and spoke" telestroke network. From 2005 to 2009, we participated in 2 time-sensitive acute stroke trials: Factor Seven for Acute Hemorrhagic Stroke and Minocycline to Improve Neurological Outcome. Candidates for the 2 trials could be identified at either the hub or at the spokes, with patients presenting to the latter transferred to the hub for enrollment. We analyzed the times from symptom onset to consultation via telemedicine, arrival at the hub, and to initiation of a study drug to determine the impact of telemedicine on study enrollment. Results-Nineteen of 28 subjects enrolled in the 2 trials were identified initially at an outside facility via a telemedicinelink. An additional 9 candidates identified by telemedicine could not be enrolled because of transportation time. for subjects who were identified via telemedicine and required transport to the hub compared with local subjects who presented directly to the hub. Conclusions-Telemedicine can enhance enrollment into time-sensitive acute stroke trials. However, transfer of subjects to the hub results in delays in study initiation for some and precludes enrollment for others similar to the weaknesses of "ship and drip" thrombolytic strategies. To save time, efforts are needed to enroll clinical trial subjects and begin the research drug at the remote site under telemedicine guidance. (Stroke. 2010;41:566-569.)

The good correlation of the smRSq with the initial stroke severity further confirms the smRSq validity in assessing functional outcome after stroke.

No abstract