mRSI - English
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When assessing outcome after stroke, the main issue that concerns patients or the regulatory authorities that license drugs or devices, is the degree of disability that the patient is left with. The degree of disability is usually assessed by an independent observer and can be scored according to a standardised scale.
The modified Rankin scale is a 6-point disability scale with possible scores for function ranging from 0 up to 5. A separate category (of 6) is usually added to classify patients who die before the assessment window. The modified Rankin scale has been used widely in both secondary prevention and acute stroke trials, including most of the thrombolysis trials and all of the thrombectomy trials; and is becoming standard for rehabilitation research alongside tailored scales.
Rankin training and certification has been in use since the beginning of the 21st century and almost every stroke clinician with a research or audit interest will hold certification. Although variations in Rankin scoring systems have been proposed from time to time - including focused assessments, automated scoring etc. - these may place unwarranted reliance on the skills of elderly, disabled patients in understanding the principles behind scoring and cannot replace the skilled judgement of an alert, trained clinician in matching functional ability to the mRS scoring rules.
In order to detect a treatment effect or to demonstrate clinical improvement, it is important that patients are rated in a consistent manner, minimising variability. This becomes especially important if patients are enrolled across multiple sites, if trial results need to be combined through meta-analysis, or if registries are used to judge outcomes from healthcare strategies or services. Use of a common ‘language’ to describe patient outcome is critical. The modified Rankin Scale has clearly defined thresholds for each level of function but both patients and clinicians inevitably perceive these in diverse ways, introducing inter-rater variation in scoring. This cannot be completely eradicated but can be minimised through working to a common protocol. The modified Rankin training program seeks to standardise the approach to scoring of mRS and the certification tools confirm that raters have understood and can apply these in practice, so that their scores fall within the same range as 90% of their peers for similar patients.
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