Improving Modified Rankin Scale Assessment With a Simplified Questionnaire

Abstract

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...

Simplified Modified Rankin Scale Questionnaire

“…The agreements on the revised questions about walking (Ն92%) and about being bedridden (Ն75%) are better than in the original smRSq (68% and 63%, respectively). 6 Repeat testing with the smRSq may have introduced recall bias. Such bias might be expected to be greater for the in-person ratings done within 20 minutes of each other than for the telephone ratings done 1 to 3 days later.…”

“…To improve the objectivity of the original smRSq, 6 we made the questions related to scores 3 to 5 more specific (Figure; Table 1). We defined the ability to walk without assistance (mRS Յ3) as able to walk without assistance from one room to another in the patient's place of residence.…”

“…4,5 We recently set out to improve the reliability of the mRS at the same time as keeping the assessments relatively simple and short and preserving the construct and validity of the original mRS. We created 5 relatively simple questions that address the key functional states assigned to each mRS score, the simplified mRS questionnaire (smRSq). 6 This questionnaire requires yes or no answers by a patient or a caregiver, takes on average only 1.67 minutes to administer, and has very good reliability (agreement 78%, ϭ0.72, and weighted [ w ]ϭ0.82). Because the agreement was weakest on the questions related to mRS scores 3 to 5 (63% to 68%), we then tried to improve the smRSq by making the 2 questions regarding mRS scores 3 to 5 more specific.…”

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

“…This was obtained via recent follow-up in our clinic or by a validated telephone questionnaire. 1 If patients were unable to participate in this questionnaire themselves, their primary caregiver was asked to participate.…”

Precision and Accuracy of Thyroid Dysfunction Questionnaire (TDQ) for Hyperthyroidism Screening in Childbearing Age Women

“…It obtained by dividing the number of frequencies of the pair observation cell on the first test and the second test. The cell true positive and negative with the total number of observations or by formula percent agreement= (a+d)/ (a+b+c+d) x100% (Biswas, 2006;Bruno et al, 2010). Kappa coefficients for dichotomous data is calculated using the formula; к= (po-pe/ 1.0-pe), which is po= (Murti, 1996;Szklo and Nieto, 20017).…”