Modified Rankin Scale (mRS)

Determines the degree of disability caused by stroke based on a clinician reported model (mRS).

There is more information about the mRS model and about the original study in the text below the tool.


The modified Rankin scale is based on a clinician reporting model accompanied by a series of question to support the assessment. It is aimed at assessing the degree of disability in stroke patients.

This Rankin scale has been in clinical use for over 30 years and has in time become a standard in the assessment of functional status of patients who suffered from a stroke.


The original Rankin scale was created by John Rankin in 1975 as a clinician reported disability scale.

The modified version which is now in use was designed by van Swieten JC in 1988 following an interobserver study on the clinical outcome in stroke.

100 patients were separately interviewed by two physicians. The varying degrees of handicap were recorded by each observer on the modified Rankin scale which has six grades.


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Disability degree after stroke

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The modified Rankin scale explained

The mRS consists of 6 degrees of disability from stroke: from no symptoms at all to severe disability and death. This is a scale aimed to be used by physicians in the assessment of functional status of stroke patients, either as a starting point or during recovery.

The higher the mRS score, the higher the degree of disability. The current scale has been in use for over 30 years and has standardized disability status, based on correlations between the score result and physiological characteristics of the stroke (such as type or lesion size) and degree of neurological impairment.

To provide a greater interobserver reliability, the scale is often used in conjunction with the following structured questionnaire:

■ Do you undergo any symptoms that are bothering you?

■ Are you able to perform your activities as you'd normally would?

■ Do you maintain your family, friend ties just like you used to?

■ Do you need help with daily household chores?

■ Do you need help during activities outside your home?

■ Do you need help performing basic personal hygiene activities?

■ Are you bedridden or in need of constant nursing care?

By using the above questions, limitations of simple observations (the main criticism of the model) can be overcome. In the overall assessment, other factors such as presence of comorbidities, should be taken into account as well.

 

About the original study

The modified Rankin scale was created by van Switen et al. in 1988 based on the original Rankin scale from 1975.

The interobserver study involved a cohort of 100 patients with different degrees of stroke handicap.

The disability degree was recorded twice (by two different clinicians) for each patient, on a scale from no symptoms to severe symptoms.

The agreement rates were corrected via kappa statistics. Agreement was observed in 65 cases and differed by one grade in 32 cases and by two grades in 3 cases.

The scale has been confirmed as an accurate assessment of stroke related disability with a satisfactory rate of interobserver agreement.

 

Original source

van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988; 19(5):604-7.

Validation

Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007; 38(3):1091-6.

Other references

1. Wilson JT, 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(4):777-81.

2. Bonita R, Beaglehole R. Modification of Rankin Scale: Recovery of motor function after stroke. Stroke. 1988; 19(12):1497-1500.


App Version: 1.0.1

Coded By: MDApp

Specialty: Neurology

System: Nervous

Objective: Assessment

Type: Scale

No. Of Items: 7

Year Of Study: 1988

Abbreviation: mRS

Article By: Denise Nedea

Published On: May 16, 2017 · 08:12 AM

Last Checked: May 16, 2017

Next Review: May 16, 2018