NINDS CDE Notice of Copyright
Modified Rankin Scale (mRS)
Modified Rankin Scale (mRS)
The Modified Rankin Scale can be found here: Modified Rankin Scale.
The van Swieten mRS scale is in the public domain. A formal tool for clinician-rater assignment of an mRS score in the public domain is the Rankin Focused Assessment (RFA) (Saver et al., 2010). Formal tools for patient/family self-assignment of an mRS score in the public domain include: 1) the short mRS questionnaire (SmRSQ) (Bruno et al., 2013), and 2) the mRS-9Q (Patel et al., 2021).
Supplemental - Highly Recommended: Unruptured Cerebral Aneurysm and Subarachnoid Hemorrhage (SAH) and Stroke (based on study type, disease stage and disease type)
Exploratory: Myasthenia Gravis (MG)
|Short Description of Instrument||
The modified Rankin Scale (mRS) is a scale commonly used for measuring the degree of disability or dependence in the daily activities of individuals who have suffered a stroke. It has become the most widely used clinical outcome measure for stroke clinical trials.
The mRS was originally introduced in 1957 by Rankin, and first modified to its currently accepted form by Charles Warlow and others as part of the UK-TIA study in the 1980s. (Broderick et al., 2017; Farrell et al., 1991) In 1988, van Swieten et al., first published the current mRS as well as the first interobserver agreement analysis of the mRS. (van Sweiten et al., 1988)
The assessment requires 5 minutes to complete.
Uses a scale from 0 to 5. For Score=1, symptoms may refer to those of a prior stroke in patients with a history of stroke.
Other Important Notes:
English and eleven different language translations are available. Consider employing a formal scoring system for the mRS such as the, the Structured Interview for the mRS, or a training program to determine the score that best describes the subject's current state. The mRS is highly reliable at pre-stroke, 30 and 90 days, and upon return to the community, but caution should be exercised when trying to apply it at hospital arrival or discharge. There are currently no published instructions on the use of the mRS to assess initial stroke disability. Raters using this at admission or discharge should develop a standard methodology and scoring instructions for use in hospital setting. The mRS is a widely used measure used to assess the functional outcomes for patients who have suffered a stroke. It can also provide a common language for describing the degree of disability.
Decisions about further medical management, the need for PT/OT therapy and the degree of care that a patient requires can be partially informed by the mRS, but final determinations should be made on an individual basis.
The mRS is used to evaluate the degree of disability in patients who have suffered a stroke, but individual quality of life and independence are influenced by a wide variety of factors including the presence of comorbidities and socioeconomic status.
The use of a structured assessment may lead to increased reliability among those conducting assessments using the mRS.
|Scoring and Psychometric Properties||
The mRS defines 6 different levels of disability, from 0 for "no symptoms at all" to 6 indicating '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.
Multiple types of evidence attest to the validity and reliability of the mRS. The reported data support the view that the mRS is a valuable instrument for assessing the impact of new stroke treatments. Inter-observer reliability of the mRS can be improved by using a structured interview, by using structured assessment forms, and by having raters undergo a multimedia training process.
The mRS "covers the entire range of functional outcomes from no symptoms to death, its categories are intuitive and easily grasped by both clinicians and patients, its concurrent validity is demonstrated by strong correlation with measures of stroke pathology (for example, infarct volumes) and agreement with other stroke scales, (Harrison et al., 2013) and its use has demarcated effective and ineffective acute stroke therapies in trials with appropriately powered sample sizes." (Broderick et al., 2017)
Even though a single-point change on the mRS is clinically relevant, with a limited number of levels the mRS may be less responsive to change than some other stroke scales. (Harrison et al., 2013) Another limitation of the mRS has been the subjective determination between categories and the reproducibility of the score by examiners and patients. (Harrison et al., 2013;Quinn et al., 2009) Reproducibility is improved with the use of formal rating systems.
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Patel N, Rao VA, Heilman-Espinoza ER, Lai R, Quesada RA, Flint AC. Simple and reliable determination of the modified rankin scale score in neurosurgical and neurological patients: the mRS-9Q. Neurosurgery. 2012 Nov;71(5):971-5; discussion 975.
Patel RD, Starkman S, Hamilton S, Craig S, Grace A, Conwit R, Saver JL. The Rankin Focused Assessment-Ambulation: A Method to Score the Modified Rankin Scale with Emphasis on Walking Ability. J Stroke Cerebrovasc Dis. 2016 Sep;25(9):2172-6.
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Document last updated February 2022