Text-message based assessment of 90-day modified Rankin Scale after Stroke

Abstract

BackgroundThe modified Rankin scale (mRS) is commonly used to measure disability after stroke, traditionally assessed through telephone or in-person evaluation. Here, we investigated the validity of mRS assessment through automated text-messaging as an alternative method to traditional assessments.MethodsTwo hundred and fifty patients admitted to 3 hospitals within the University of Pennsylvania Health System with ischemic or hemorrhagic stroke were enrolled. Participants received automated text-messages sent 48 hours prior to their outpatient appointment at about 90-days post-stroke. The mRS scores were assigned based on participant responses to 2-4 text questions eliciting yes/no responses. The mRS was then evaluated in-person or by telephone interview for comparison. Responses were compared with kappa(κ).ResultsOne hundred and forty-two patients (57%) completed the study. Spontaneous response rate to text messages was 46% and up to 72% with an additional direct in-person or phone call reminder. Agreement was substantial (quadratic-weighted κ=0.87) between responses derived from the automated text messaging and traditional interviews. Agreement for distinguishing functional independence (mRS 0-2) from dependence (mRS 3-5) was substantial (unweighted κ=0.79).ConclusionAn automated text messaging system is a feasible and highly reliable for determining mRS and can serve as an alternative to traditional in-person or telephone assessment.