Validation of a Structured Interview for Telephone Assessment of the Modified Rankin Scale in Brazilian Stroke Patients

Abstract

Background: The modified Rankin Scale (mRS) is a commonly used scale to assess the functional outcome after stroke. Several studies on mRS showed good reliability, feasibility, and interrater agreement of this scale using a face-to-face assessment. However, telephone assessment is a more time-efficient way to obtain an mRS grade than a face-to-face interview. The aim of this study was to validate the telephone assessment of mRS among the Portuguese using a structured interview in a sample of Brazilian stroke patients. Methods: We evaluated 50 stroke outpatients twice. The first interview was face-to-face and the second was made by telephone and the time between the two assessments ranged between 7 and 14 days. Four certified raters evaluated the patients using a structured interview based on a questionnaire previously published in the literature. Raters were blinded for the Rankin score given by the other rater. For both assessments, the rater could also interview a caregiver if necessary. Results: The patients' mean age was 62.8 ± 14.7, mean number of years of study 5.2 ± 3.4, 52% were males, 55.2% of patients needed a caregiver's help to answer the questions. The majority of caregivers were female (85%), mean age 49.1 ± 15, and mean number of years of study 8.3 ± 3.4. Perfect agreement between the telephone and face-to-face assessments was obtained for 27 (54%) patients, corresponding to an unweighted Kappa of 0.44 (95% CI 0.27-0.61) and a weighted Kappa of 0.89. The median of telephone assessment mRS was 3.5 (interquartile range = 2-4) and of face-to-face assessment was 4 (interquartile range = 2-5). There was no difference between the two assessments (Wilcoxon test, p = 0.35). Conclusions: Despite the low education level of our sample, the telephone assessment of functional impairment of stroke patients using a translated and culturally adapted Brazilian Portuguese version of the mRS showed good validity and reliability. Therefore, the telephone assessment of mRS can be used in clinical practice and scientific studies in Brazil.

How Many Patients Become Functionally Dependent after a Stroke? A 3-Year Population-Based Study in Joinville, Brazil

“…Although reliable and validated, functional assessments were performed by telephone, these are less ideal than face-to-face interviews [19]. We understand information bias in our sample is unlikely because our register had a trained nurse who used a validated scale for Rankin assessment by telephone call [20]. The strength of our data is the population-based sampling, which used ideal criteria of overlapping sources for stroke ascertainment [13].…”

“…Patients with 0 to 2 points were classified as independent and with 3 to 5 as dependent. A previously trained nurse called all patients or relatives at 12, 24 and 36 months after the stroke event, using a validated Brazilian version of the Rankin scale interview for telephone assessment [20]. …”

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

“…If not, a Portuguese validated telephone evaluation was used to determine the score [20]. Patients were divided into 2 groups for comparison: those with a score ≤3 and those with a score >3.…”

Estudo de viabilidade e desenvolvimento de sistema de telemedicina para o acidente vascular cerebral agudo na região de Ribeirão Preto - SP - Brasil

“…Ao término da aplicação da escala, a soma dos itens é feita automaticamente e fica registrada no campo NIHSS. Com dados de anamnese e exame físico o neurologista poderá registrar a classificação Bamford (BAMFORD et al, 1991) A próxima aba da tela é denominada "Evolução", que se destina ao registro da investigação etiológica, com resultados dos exames essenciais e complementares, de intercorrências hospitalares e das discussões entre equipes de saúde nos dias subsequentes à admissão (figura 13).  Intercorrências e procedimentos realizados (com opções para marcar sim/não): neurocirurgia, transformação hemorrágica sintomática, arteriografia ou angioplastia, outro (com escrita livre).…”

“… Grau de independência funcional do paciente no momento da alta (escala de Rankin modificada, com opções para assinalar de 0 a 6) (BAGGIO et al, 2014).…”