From the Guidelines
The Modified Rankin Scale (mRS) is a 7-point clinical outcome scale that measures a patient’s function and independence, ranging from 0 (no symptoms) to 6 (death), with a lower score indicating a better outcome. The mRS is a widely used outcome measure in stroke research and clinical practice, helping clinicians make treatment decisions and set realistic rehabilitation goals based on objective measurements of functional status 1. The scale is particularly valuable for monitoring patient recovery over time, evaluating the effectiveness of interventions, and standardizing outcomes in clinical trials for stroke treatments.
Key Features of the Modified Rankin Scale
- The mRS consists of seven grades:
- 0: No symptoms
- 1: No significant disability despite symptoms; able to carry out all usual duties and activities
- 2: Slight disability; unable to carry out all previous activities but able to look after own affairs without assistance
- 3: Moderate disability; requiring some help but able to walk without assistance
- 4: Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
- 5: Severe disability; bedridden, incontinent, and requiring constant nursing care and attention
- 6: Dead
- A lower score on the mRS indicates a better outcome, with scores of 0 to 1 generally considered an excellent functional outcome, a score of 2 considered a good functional outcome, and scores of 3 to 6 considered a poor functional outcome 1.
Clinical Application of the Modified Rankin Scale
The mRS is used to assess the degree of disability or dependence in daily activities for patients who have suffered a stroke or other neurological injuries. Healthcare providers typically administer the mRS through a structured interview, asking about the patient's ability to perform activities of daily living and their level of independence. The scale is useful for monitoring patient recovery over time and evaluating the effectiveness of interventions, such as intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke 1.
Importance of the Modified Rankin Scale in Clinical Trials
The mRS is a key outcome measure in clinical trials for stroke treatments, allowing for the standardization of outcomes and the comparison of treatment effects across different studies. The scale is particularly useful for evaluating the effectiveness of interventions aimed at improving functional outcomes, such as IV tPA and mechanical recanalization strategies 1.
Limitations and Future Directions
While the mRS is a widely used and well-established outcome measure, it has some limitations, such as its subjective nature and potential for variability in scoring. Future studies should continue to evaluate the reliability and validity of the mRS and explore the development of new outcome measures that can provide a more comprehensive assessment of functional status and quality of life in patients with stroke.
From the Research
Overview of the Modified Rankin Scale
- The Modified Rankin Scale (mRS) is a widely used tool to quantify post-stroke disability in clinical practice and research 2, 3, 4, 5, 6.
- It is used to assess the level of disability or dependence in patients after a stroke, with scores ranging from 0 (no symptoms) to 5 (severe disability) and 6 (death) 2, 4.
Reliability and Interobserver Variability
- Studies have shown that the mRS has moderate to good reliability, with kappa values ranging from 0.25 to 0.95 6.
- Interobserver variability can affect the reliability of the mRS, particularly in retrospective observational studies 2, 6.
- Certified raters and structured interviews can improve the reliability of the mRS 4, 6.
Use in Clinical Practice and Research
- The mRS is commonly used in clinical trials and observational studies to assess outcomes in stroke patients 3, 5.
- It is also used to predict functional outcomes and determine the need for rehabilitation and long-term care 3.
- The mRS can be used in conjunction with other scales, such as the National Institutes of Health Stroke Scale (NIHSS) and the modified Thrombolysis in Cerebral Infarction (mTICI), to provide a comprehensive assessment of stroke severity and outcomes 3.