Modified Rankin Scale Explained

Modified Rankin Scale
Purpose:	measure degree of disability (stroke)

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 as a 5-level scale ranging from 1 to 5.^{[1] [2]} It was then modified by either van Swieten et al.^[3] or perhaps Prof. C. Warlow's group at Western General Hospital in Edinburgh for use in the UK-TIA study in the late 1980s to include the value '0' for patients who had no symptoms.^[4] As late as 2005^[5] the scale was still being reported as ranging from 0 to 5. Somewhere between 2005 and 2008 the final change was made to add the value '6' to designate patients who had died. The modern version of modified version differs from Rankin's original scale mainly in the addition of grade 0, indicating a lack of symptoms, and the addition of grade 6 indicating dead.

Interobserver reliability of the mRS can be improved by using a structured questionnaire during the interview process^{[6] [7]} and by having raters undergo a multimedia training process.^[8] 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.^[9]

More recently, several tools have been developed to more systematically determine the mRS, including the mRS-SI,^[10] the RFA,^[11] and the mRS-9Q.^[12] The mRS-9Q is in the public domain and free web calculators are available at modifiedrankin.com and mdcalc.com.__TOC__

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
• Glasgow outcome scale
• strokecenter.org list of stroke assessment scales (external link)

Notes and References

1. Quinn TJ, Dawson J, Walters M . Dr John Rankin; his life, legacy, and the 50th anniversary of the Rankin Stroke Scale . Scott Med J . 2008 . 53 . 1 . 44–7 . 18422210 . 10.1258/rsmsmj.53.1.44. 34909404 .
2. Rankin J . Cerebral vascular accidents in patients over the age of 60. II. Prognosis . Scott Med J . 2 . 5 . 200–15 . May 1957 . 13432835. 10.1177/003693305700200504 . 29669359 .
3. van Swieten. J C. Koudstaal. P J. Visser. M C. Schouten. H J. van Gijn. J. May 1988. Interobserver agreement for the assessment of handicap in stroke patients.. Stroke. en. 19. 5. 604–607. 10.1161/01.STR.19.5.604. 3363593 . 0039-2499. free.
4. 10.1136/jnnp.54.12.1044 . Farrell B, Godwin J, Richards S, Warlow C, etal . The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. . J Neurol Neurosurg Psychiatry . 1991 . 54 . 1044–1054 . 1783914 . 12 . 1014676.
5. Wilson. J. T. Lindsay. Hareendran. Asha. Hendry. Anne. Potter. Jan. Bone. Ian. Muir. Keith W.. April 2005. Reliability of the Modified Rankin Scale Across Multiple Raters: Benefits of a Structured Interview. Stroke. en. 36. 4. 777–781. 10.1161/01.STR.0000157596.13234.95. 15718510 . 0039-2499. free.
6. 10.1161/01.STR.0000027437.22450.BD . Wilson JL, Hareendran A, Grant M, etal . Improving the Assessment of Outcomes in Stroke: Use of a Structured Interview to Assign Grades on the Modified Rankin Scale. . Stroke . 2002 . 33 . 2243–2246 . 12215594 . 9. free .
7. Wilson JL, Hareendran A, Hendry A, etal . Reliability of the Modified Rankin Scale Across Multiple Raters: Benefits of a Structured Interview. . Stroke . 2005 . 36 . 777–781 . 15718510 . 4 . 10.1161/01.STR.0000157596.13234.95 . free .
8. Quinn TJ, Lees KR, Hardemark HG, etal . Initial experience of a digital training resource for modified Rankin scale assessment in clinical trials. . Stroke . 2007 . 38 . 2257–2261 . 17600236 . 8 . 10.1161/STROKEAHA.106.480723 . free .
9. Web site: Modified Rankin Scale for Neurologic Disability . MDCalc . 2015-02-17.
10. Bruno A, Shah N, Lin C, etal . Improving modified Rankin Scale assessment with a simplified questionnaire . Stroke . 41 . 5 . 1048–50 . 2010 . 20224060 . 10.1161/STROKEAHA.109.571562. free .
11. Saver JL, Filip B, Hamilton S, etal . Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA) . Stroke . 41 . 5 . 992–95 . 2010 . 20360551 . 10.1161/STROKEAHA.109.571364 . 2930146.
12. Patel N, Rao VA, Heilman-Espinoza ER, Lai R, Quesada RA, Flint AC . Simple and reliable determination of the modified Rankin Scale in neurosurgical and neurological patients: The mRS-9Q . Neurosurgery . July 2012 . 22843133 . 10.1227/NEU.0b013e31826a8a56 . 71 . 5 . 971–5; discussion 975.