Background: The modified Rankin scale (mRS) is commonly employed as a measure of functional outcome after stroke. The purpose of this study was to investigate the reliability of the mRS using an expanded guidance scheme and a corresponding questionnaire on an unprecedentedly large scale. Methods: Neurologists interviewed patients with cerebral infarction on the basis of the questionnaire. These interviews were recorded on videotape. Raters (10 neurologists, 6 nurses and 4 physiotherapists) watched the videotapes of 30 patients interviewed and assessed the mRS according to the guidance scheme. Results: The agreement between the raters, as estimated from the intraclass correlation coefficient, was found to be satisfactory with values of 0.947 for neurologists and 0.963 for nurses and physiotherapists. The reproducibility was also satisfactory with values of 0.865 and 0.871, respectively. Conclusion: The data obtained suggest that our guidance scheme and questionnaire are useful for ensuring the quality of assessments made with the mRS.

1.
Clark WM, Hourihane JM: Clinical stroke scales; in Herndon RM (ed): Handbook of Neurologic Rating Scales. New York, Demos Vermande, 1997, pp 161–186.
2.
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJA, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–607.
3.
Jennett B, Bond M: Assessment of outcome after severe brain damage: a practical scale. Lancet 1975;i:480–484.
4.
Mahoney FI, Barthel DW: Functional evaluation: The Barthel Index. Md Med J 1965;14:61–65.
5.
Wilson JTL, Hareendran A, Grant M, Baird T, Schulz UGR, Muir KW, Bone I: 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.
6.
Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200–215.
7.
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581–1587.
8.
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA 1999;282:2003–2011.
9.
Lyden P, Shuaib A, Ng K, Levin K, Atkinson RP, Rajput A, Wechsler L, Ashwood T, Claesson L, Odergren T, Salazar-Grueso E: Clomethiazole acute stroke study in ischemic stroke (CLASS-I): final results. Stroke 2002;33:122–129.
10.
Wolf CDA, Taub NA, Woodrow EJ, Burney PGJ: Assessment of scales of disability and handicap for stroke patients. Stroke 1991;22:1242–1244.
11.
Wilson JTL, Hareendran A, Hendry A, Potter J, Bone I, Muir KW: Reliability of the modified Rankin scale across multiple raters: benefits of a structured interview. Stroke 2005;36:777–781.
12.
Kimura K, Kazui S, Minematsu K, Yamaguchi T; Japan Multicenter Stroke Investigators’ Collaboration (J-MUSIC): Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. Cerebrovasc Dis 2004;18:47–56.
13.
Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420–428.
14.
Ohta T, Kikuchi H, Hashi K, Kudo Y: Nizofenone administration in the acute stage following subarachnoid hemorrhage. J Neurosurg1986;64:420–426.
15.
Larry BG, Gregory PS: Reliability of the National Institutes of Health Stroke Scale: extension to non-neurologists in the context of a clinical trial. Stroke 1997;28:307–310.
16.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.
17.
Kusunoki T, Inomata T, Homma A, Hirai S: Reliability of a rating scale to assess post-stroke psychiatric symptoms. Psychogeriatrics 2001;1:69–75.
18.
Wilson JTL, Hareendran A: Structured interview for the Modified Rankin Scale: questionnaire and guidelines. http://www.psychology.stir.ac.uk/staff/lwilson/documents/MRS_Structured_Interview.pdf2002.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.