Modified Rankin Scale

The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It has become the most widely used clinical outcome measure for stroke clinical trials.

The scale was originally introduced in 1957 by Dr. John Rankin of Stobhill Hospital, Glasgow, Scotland,^[1][2] and then modified to its currently accepted form by Prof. C. Warlow's group at Western General Hospital in Edinburgh for use in the UK-TIA study in the late 1980s.^[3] The first publication of the current modified Rankin Scale was in 1988 by van Swieten, et al., who also published the first interobserver agreement analysis of the modified Rankin Scale.^[4]

Interobserver reliability of the mRS can be improved by using a structured questionnaire during the interview process^[5][6] and by having raters undergo a multimedia training process.^[7] The multimedia mRS training system which was developed by Prof. K. Lees' group at the University of Glasgow is available online. The mRS is frequently criticized for its subjective nature which is viewed as skewing results, but is used throughout hospital systems to assess rehabilitation needs and outpatient course. These criticisms were addressed by researchers creating structured interviews which ask simple questions both the patient and/or the caregiver can respond to.^[5][8]

More recently, several tools have been developed to more systematically determine the mRS, including the mRS-SI,^[9] the RFA,^[10] and the mRS-9Q.^[11] The mRS-9Q is in the public domain and a free web calculator is available at www.modifiedrankin.com.

The Modified Rankin Scale (mRS)

The scale runs from 0-6, running from perfect health without symptoms to death.

• 0 - No symptoms.
• 1 - No significant disability. Able to carry out all usual activities, despite some symptoms.
• 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.
• 3 - Moderate disability. Requires some help, but able to walk unassisted.
• 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted.
• 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent.
• 6 - Dead.

See also

• Barthel scale
• Cincinnati Stroke Scale (just for diagnosis of stroke)

References

1. Quinn TJ, Dawson J, Walters M (2008). "Dr John Rankin; his life, legacy, and the 50th anniversary of the Rankin Stroke Scale". Scott Med J. 53 (1): :44–7. PMID 18422210.
2. Rankin J (May 1957). "Cerebral vascular accidents in patients over the age of 60. II. Prognosis". Scott Med J. 2 (5): 200–15. PMID 13432835.
3. Farrell B, Godwin J, Richards S, Warlow C, et al. (1991). "The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results.". J Neurol Neurosurg Psychiatry. 54 (12): 1044–1054. doi:10.1136/jnnp.54.12.1044. PMC 1014676. PMID 1783914.
4. van Swieten J, Koudstaal P, Visser M, Schouten H, et al. (1988). "Interobserver agreement for the assessment of handicap in stroke patients.". Stroke. 19 (5): 604–607. doi:10.1161/01.str.19.5.604. PMID 3363593.
5. Wilson JL, Hareendran A, Grant M, et al. (2002). "Improving the Assessment of Outcomes in Stroke: Use of a Structured Interview to Assign Grades on the Modified Rankin Scale.". Stroke. 33 (9): 2243–2246. doi:10.1161/01.STR.0000027437.22450.BD. PMID 12215594.
6. Wilson JL, Hareendran A, Hendry A, et al. (2005). "Reliability of the Modified Rankin Scale Across Multiple Raters: Benefits of a Structured Interview.". Stroke. 36 (4): 777–781. doi:10.1161/01.STR.0000157596.13234.95. PMID 15718510.
7. Quinn TJ, Lees KR, Hardemark HG, et al. (2007). "Initial experience of a digital training resource for modified Rankin scale assessment in clinical trials.". Stroke. 38 (8): 2257–2261. doi:10.1161/STROKEAHA.106.480723. PMID 17600236.
8. "Modified Rankin Scale for Neurologic Disability". MDCalc. Retrieved 2015-02-17.
9. Bruno A, Shah N, Lin C, et al. (2010). "Improving modified Rankin Scale assessment with a simplified questionnaire". Stroke. 41 (5): 1048–50. doi:10.1161/STROKEAHA.109.571562. PMID 20224060.
10. Saver JL, Filip B, Hamilton S, et al. (2010). "Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA)". Stroke. 41 (5): 992–95. doi:10.1161/STROKEAHA.109.571364. PMC 2930146. PMID 20360551.
11. Patel N, Rao VA, Heilman-Espinoza ER, Lai R, Quesada RA, Flint AC (July 2012). "Simple and reliable determination of the modified Rankin Scale in neurosurgical and neurological patients: The mRS-9Q". Neurosurgery. 71 (5): 971–5; discussion 975. doi:10.1227/NEU.0b013e31826a8a56. PMID 22843133.