Modified Rankin Scale (MRS)

 

Modified Rankin Scale (MRS) Evaluation Summary

  What does the tool measure? Level of post-stroke functional independence.
  What types of clients can the tool be used for? Patients with stroke.
  Is this a screening or assessment tool? Assessment
Time to administer The MRS takes 5-15 minutes to administer.
  Versions Original Rankin Scale (RS), Modified Rankin Scale-Structured Interview (MRS-SI)
Other Languages German, Persian, Dutch
Measurement Properties
  Reliability – No studies have examined the internal consistency of the MRS.
– Two studies have examined the test-rest reliability of the MRS and reported excellent test-retest.
– Six studies have examined the inter-rater reliability of the MRS. Two reported adequate to excellent, three reported excellent inter-rater (note: one study used an expanded guidance scheme – guided interview format -, two reported systematic differences between raters using ANOVA), and one reported poor inter-rater reliability.
– Only one study has examined the intra-rater reliability of the MRS and reported excellent intra-rater reliability.
  Validity

Criterion:
Concurrent:
Excellent correlations with the Barthel IndexFrenchay Activities Index, the motor component of the Functional Independence MeasureShort Form-36 Physical Functioning subscale and the Euroqol 5D.Adequate correlations with the Stroke-Adapted Sickness Impact Profile-30 and the Glasgow Coma Scale as well as adequate to excellent correlations with Magnetic Resonance Imaging (MRI) findings.
Predictive: The most relevant predictors were MRS scores before the stroke event, the presence of diabetes, and severity of left arm weakness.

Construct:
Convergent/Discriminant:
One study reported that the MRS was closely related to the Glasgow Outcome Scale, the NIH Stroke Scale, and the Barthel Index. One study reported an excellent correlation between the MRS and the Barthel Index. One study reported adequate to excellent correlations between the MRS and 5 impairment scales (the Orgogozo Scale, the NIH Stroke Scale, the Canadian Neurological Scale, the Mathew scale, and the Scandinavian Stroke Scale). Finally, one study reported a weak correlation between the MRS and the Sickness Impact Profile subscales of Cognitive Alertness and Social Interaction.

  Floor/Ceiling Effects One study examined the floor effects of the MRS and reported an adequate floor effect.
  Does the tool detect change in patients? One study examined the responsiveness of the MRS when administered to stroke rehabilitation inpatients at admission and discharge and reported that the MRS was poor at detecting change.
  Acceptability The MRS has not been evaluated for use with proxy respondents.
Feasibility The MRS is single item, global outcomes rating scale that takes 5 -15 minutes to administer and does not require any formal training or specialized equipment. The categories of the MRS have been criticized for being broad, poorly defined and left open to rater interpretation. The MRS- Structured Interview (MRS-SI) differs from the conventional guided interview format of the MRS by defining specific questions to grade each category. Inter-rater reliability of the MRS has been shown to improve with the use of this structured interview format.
How to obtain the tool? Please click here to obtain a copy of the MRS.