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Shyam Prabhakaran - One of the best experts on this subject based on the ideXlab platform.

  • Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures
    Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2020
    Co-Authors: Robert L. Askew, Carmen E. Capo-lugo, Rajbeer S Sangha, Andrew M. Naidech, Shyam Prabhakaran
    Abstract:

    Abstract Introduction We aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by Modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure. Methods Mean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences. Results Seven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44). Conclusions Findings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.

  • abstract tp332 neuro qol measures have improved statistical power versus the dichotomized Modified Rankin Scale in stroke thrombolysis
    Stroke, 2016
    Co-Authors: Rajbeer S Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Ilana Ruff, Shyam Prabhakaran
    Abstract:

    Introduction: The Modified Rankin Scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-Q...

  • abstract tp332 neuro qol measures have improved statistical power versus the dichotomized Modified Rankin Scale in stroke thrombolysis
    Stroke, 2016
    Co-Authors: Rajbeer Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Ilana Ruff, Shyam Prabhakaran
    Abstract:

    Introduction: The Modified Rankin Scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL provide validated measures of patient-reported outcomes. In a matched case-control study, we hypothesized that differences in QOL in favor of tPA would be readily detectable compared to the dichotomous mRS outcome traditionally applied in acute stroke research. Methods: From a single-center prospective cohort study, we identified ischemic stroke patients who received intravenous tPA, admitted between August 1, 2012 and July 31, 2014, and who had 3-month QOL and mRS outcomes. Using a propensity score matching algorithm based on age and stroke severity, ischemic stroke patients who did not receive tPA were selected as controls. The mRS was assessed by structured telephone interviews and Neuro-QOL using short forms analyzing domains of upper extremity (UE), lower extremity (LE), executive function (EF), and general cognition (GC). T-scores for Neuro-QOL domains are referenced to the general population (mean 50, SD 10). We assessed differences in mRS (dichotomized 0-1 vs. 2-5) and QOL T-scores (continuous) in each domain using appropriate tests. Results: A total of 90 patients were analyzed (45 tPA and 45 controls; median NIHSS score 7). There was no statistical difference between the two groups by age (p=0.967) and NIHSS score (p=0.855). When comparing Neuro-QOL T-scores, higher scores were reported for domains of EF (tPA: 52 vs. controls: 46; p=0.032) and LE function (tPA: 46 vs. controls: 41; p=0.008) among tPA patients compared to controls. No differences were noted for UE or GC QOL T-scores. Using the mRS, the results were not statistically significant (dichotomous: 0-1, tPA: 75.6% vs. controls: 57.8%, p=0.117). Conclusion: Neuro-QOL offers a complementary tool for assessment of neurological function and may help identify finer grades of functional change and outcomes for stroke patients undergoing a specific therapy. The mRS requires a greater number of patients to show statistical significance while utilization of a continuous measurement of function from the patient perspective may improve statistical power in future clinical trials.

  • neuro qol for assessment of cognitive impairment after stroke comparison with Modified Rankin Scale p2 116
    Neurology, 2014
    Co-Authors: Rajbeer Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Deborah Bergman, Shyam Prabhakaran
    Abstract:

    OBJECTIVE: A comparison of Neuro-QOL: cognitive health domains with mRS in acute ischemic stroke BACKGROUND: The Modified Rankin Scale (mRS) is a reliable objective measure of disability which has been widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL acts as a continuous measurement of function from the patient perspective and provides validated measures of patient- reported outcomes. We compared QOL scores in cognitive health domains with mRS scores at 3 months after ischemic stroke or transient ischemic attack (TIA). Neuro- QOL measures included applied cognition - executive function (EF) and applied cognition - general concerns (GC). DESIGN/METHODS: From a single-center prospective cohort study, we identified ischemic stroke and TIA patients admitted between August 2012 and April 2013 who survived to 3-month follow-up and underwent mRS and Neuro-QOL outcomes assessments at 3 months. The mRS were assessed by structured telephone interviews and Neuro-QOL scores using short forms of executive function (EF) and general concerns (GC). We assessed the correlation between Neuro-QOL and mRS scores and evaluated the range of Neuro-QOL scores and identified mean T-scores in each mRS strata. RESULTS: Three-hundred twelve patients met study criteria (mean age 65.2 years; initial NIHSS score 4; 77.2% ischemic stroke). At 3 months, mean GC and EF T-scores were 53.5 (SD 7.7) and 51.3 (SD 10.5), respectively. Modest correlations were noted between mRS and cognitive function QOL T-scores at 3 months were mRS-EF: rs = -0.452 and mRS- GC: rs = -0.503. However, the range of T-scores was wide within mRS strata and correlation was non-linear. Among those with mRS 0-1, 19 of 252 patients (7.5%) had impaired Neuro-QOL GC or EF (> 1 SD below mean). CONCLUSIONS: The mRS correlates modestly but non-linearly with patient-reported scores of cognitive function using Neuro-QOL. Some patients report impairments in cognitive function despite no disability by mRS (i.e. 0-1). Therefore, Neuro-QOL provides a complementary tool for assessment of cognitive function after stroke. Disclosure: Dr. Sangha has nothing to disclose. Dr. Corado has nothing to disclose. Dr. Bergman has nothing to disclose. Dr. Naidech has received research support from Gaymar Inc. Dr. Cella has received personal compensation for activities with Moffit Caner Center. Dr. Bernstein has received personal compensation for activities with Boehringer Ingelheim Pharmaceuticals, Inc., and Pfizer Inc. Dr. Curran has nothing to disclose. Dr. Prabhakaran has received personal compensation for activities with American Heart Association.

  • abstract t p286 comparison of neuro qol physical function and Modified Rankin Scale in stroke
    Stroke, 2014
    Co-Authors: Rajbeer S Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Deborah Bergman, Shyam Prabhakaran
    Abstract:

    Introduction: The Modified Rankin Scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL provide validated measures of patient-reported outcomes. We compared changes in physical function QOL scores with transitions in mRS scores after ischemic stroke or transient ischemic attack (TIA). Methods: From a single-center prospective cohort study, we identified ischemic stroke and TIA patients admitted between August 2012 and April 2013 who survived to 3-month follow-up and underwent mRS and Neuro-QOL outcomes assessments at 1 and 3 months. The mRS was assessed by structured telephone interviews and Neuro-QOL scores using short forms of upper extremity (UE) and lower extremity (LE) function. We used Pearson9s coefficient to compare mRS and Neuro-QOL scores and assessed mean changes in Neuro-QOL T-scores across mRS strata and between 1 and 3 months. Results: Three-hundred twelve patients met study criteria (mean age 65.2 years; initial NIHSS score 4; 77.2% ischemic stroke). Strong correlations were noted between mRS and physical function QOL scores at 3-months: mRS-LE: r = -0.74; mRS-UE: r = -0.74. UE and LE QOL scores were 6.1 and 7.1 points lower, respectively, in those with mRS of 1 compared with 0. Within individual patients, a 1 point decrease (improvement) in mRS was associated with increase in UE and LE QOL by 5.6 and 3.3 points while a 1 point increase (worsening) in mRS was associated with a decrease in UE and LE QOL by 4.0 and 7.5 points, respectively. By mRS, 7.5% of patients had worsening by at least 1 point between 1 and 3 months while the proportion with at least 1 standard deviation (10 points) decrease in UE or LE QOL scores was 12.1% and 14.4%, respectively. Conclusions: The mRS correlates well with patient-reported scores of physical function using Neuro-QOL. However, Neuro-QOL offers a complementary tool for assessment of neurological function and may help identify finer grades of functional change over time. Using a continuous measurement of function from the patient perspective may also be more valuable to patients and improve statistical power in clinical trials.

Askiel Bruno - One of the best experts on this subject based on the ideXlab platform.

  • Initial testing of an electronic application of the simplified Modified Rankin Scale questionnaire (e-smRSq).
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2020
    Co-Authors: Dipankar Dutta, Chris Foy, Gopinath Ramadurai, Mudhar Obaid, Askiel Bruno
    Abstract:

    Abstract Introduction and purpose To facilitate Modified Rankin Scale (mRS) assessments, we developed and tested a smartphone/web application of the simplified mRS questionnaire (e-smRSq). The e-smRSq guides raters towards a final score according to the smRSq algorithm, and offers hints for scoring based on the conventional mRS concepts. Methods Initially, three experienced mRS certified raters prepared 30 vignettes of unstructured stroke patient interviews, and determined consensus reference scores. Using the e-smRSq, 16 raters of varied professional backgrounds without mRS training scored the mRS for 24 randomly selected vignettes. Subsequently, 5 certified and 5 uncertified raters using the e-smRSq scored 23 mRS certification vignettes developed and used in the Strategies to Innovate Emergency Care Clinical Trials Network-Neurological Emergencies Treatment Trials (SIREN-NETT). Cohen's and Fleiss's kappa (κ), weighted kappa (κw), and intra-class correlation (ICC) compared rater scores with reference scores and assessed interrater reliability. Results For the 16 initial raters using the e-smRSq with 24 vignettes, the κ (Fleiss) was 0.62 and ICC 0.87 (CI 0.80–0.93). Comparing raters’ scores with reference scores, Cohen's κ was 0.68 and κw 0.90. For the 10 subsequent raters using the e-smRSq on SIREN-NETT vignettes, κ (Fleiss) was 0.8 and ICC 0.95 (CI 0.91–0.97). Comparing all 10 raters scores with SIREN-NETT reference scores, Cohen's κ was 0.88 and κw 0.97. There was no significant difference between certified and uncertified raters. Conclusions The e-smRSq appears to have good reproducibility and validity metrics among both certified and non-certified mRS raters, possibly owing to its simplicity. Further testing in stroke patients in warranted.

  • the reliability and validity of a novel chinese version simplified Modified Rankin Scale questionnaire 2011
    BMC Neurology, 2020
    Co-Authors: Yunxiao Wang, Junliang Yuan, Askiel Bruno
    Abstract:

    The Modified Rankin Scale (mRS) is a key global outcome measure after stroke internationally. The latest English version of the simplified Modified Rankin Scale questionnaire (smRSq)(2011) is a reliable and valid tool in scoring the mRS after stroke. In order to use this tool in Chinese patients, we translated it into Chinese and tested its clinimetric properties. The English version smRSq (2011) was translated into Chinese by a standard process. We recruited 300 consecutive hospitalized ischemic stroke patients in the department of neurology, Beijing Chaoyang Hospital. Six randomly paired raters scored the conventional mRS, the novel Chinese version smRSq (2011), the National Institutes of Health Stroke Scale (NIHSS), and the Barthel index (BI) in-person. Inter-rater reliability and validity were assessed. Among the 300 ischemic stroke patients, mean age was 64.9 ± 12.1 years, and 220 (73%) were male. For inter-rater reliability of the smRSq (2011), the percent agreement among the paired raters was 87%, the kappa (κ) was 0.84 (95% CI, 0.79–0.88), and the weighted kappa (κw) was 0.96 (95% CI, 0.95–0.98). The percent agreement between the smRSq (2011) scores and the conventional mRS scores was 55%, κ = 0.47 (95% CI, 0.40–0.54), and κw = 0.91 (95% CI, 0.89–0.93). In construct validity testing, the Spearman’s correlation coefficients comparing the smRSq (2011) scores with the NIHSS and the BI scores were 0.83 (P < 0.001) and − 0.86 (P < 0.001), respectively. Our results show good to excellent clinimetric properties of the novel Chinese version smRSq (2011) in scoring the mRS in Chinese stroke patients. Further validation in other clinical settings, including in communities and by remote methods in China is warranted.

  • reader response ordinal vs dichotomous analyses of Modified Rankin Scale 5 year outcome and cost of stroke
    Neurology, 2019
    Co-Authors: Askiel Bruno
    Abstract:

    This important observation about the frequently reported prestroke Modified Rankin Scale (mRS)1 is worthy of consideration. The mRS was not designed for use before brain injury.2,3 Scoring the mRS categories 0–2 requires a comparison between prestroke and poststroke functional states, which is not possible prestroke.

  • Simplified Modified Rankin Scale questionnaire correlates with stroke severity
    Clinical rehabilitation, 2013
    Co-Authors: Askiel Bruno, Brian Close, David C. Hess, Jeffrey A. Switzer, Fenwick T Nichols, Hartmut Gross, Abiodun Emmanuel Akinwuntan
    Abstract:

    Objective:To further validate the simplified Modified Rankin Scale questionnaire (smRSq), we compare it here to a well-established predictor of functional outcome after stroke, the initial stroke severity.Design:Retrospective correlation analysis.Participants:Forty patients identified from a registry of stroke patients treated with intravenous tissue plasminogen activator.Setting:Community and 17 hospital Emergency Departments within a web-based telestroke network throughout the state of Georgia, USA.Measures:Five certified raters assessed the initial stroke severities with the National Institutes of Health Stroke Scale (NIHSS) via the telestroke system. Over a 20 month period, one certified rater, unaware of the NIHSS scores, attempted to contact each patient in the registry to assess their functional outcomes with the smRSq via telephone. We analyzed patients who had the smRSq assessment at least three months after stroke.Results:Forty of 120 registered patients were contacted and qualified for this stu...

  • Stroke size correlates with functional outcome on the simplified Modified Rankin Scale questionnaire.
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2012
    Co-Authors: Askiel Bruno, Abiodun Emmanuel Akinwuntan, Brian Close, Neel Shah, Jeffrey A. Switzer
    Abstract:

    Background Acute stroke size is one of the factors impacting functional outcome. To further validate the simplified Modified Rankin Scale questionnaire (smRSq), we tested its correlation with stroke size. Methods We screened 60 ischemic stroke patients with acute brain images available for stroke volume measurement who were enrolled in 2 smRSq reliability studies. Inclusion criteria were acute ischemic stroke visible on computed tomography (CT) or magnetic resonance imaging (MRI) and the smRSq scored at least 3 months after stroke. We excluded patients with disabilities from a previous stroke. One investigator who was blinded to the functional outcomes measured stroke volumes with a specialized computer program (Analyze). We used MRI when both MRI and CT were available. We classified strokes into 2 size categories: lacunar type measuring ≤6.28 cm 3 , which corresponds to a cylinder with a maximum diameter and height of 2.00 cm, or strokes >6.28 cm 3 . The Spearman correlation analysis compared the smRSq between the lacunar type and the larger strokes. Results Thirty-two patients qualified for this analysis with a mean age of 59 ± 15 years, and 17 (53%) were men. Lacunar stroke volumes (n = 17) ranged from 0.03 to 4.58 cm 3 , and the larger stroke volumes (n = 15) ranged from 11.52 to 250.02 cm 3 . Lacunar strokes were associated with lower smRSq scores (median 1) than the larger strokes (median 4; r=0.68; R 2 = 0.46; P Conclusions Acute stroke size correlates well with the smRSq, supporting its validity in assessing functional outcome after stroke.

Jeffrey L. Saver - One of the best experts on this subject based on the ideXlab platform.

  • standardized nomenclature for Modified Rankin Scale global disability outcomes consensus recommendations from stroke therapy academic industry roundtable xi
    Stroke, 2021
    Co-Authors: Jeffrey L. Saver, James C. Grotta, Maarten G Lansberg, Chitra Venkatasubramanian, Napasri Chaisinanunkul, Bruce C V Campbell, Michael D Hill, Pooja Khatri, Jaren Landen, Gregory W Albers
    Abstract:

    The Modified Rankin Scale (mRS), a 7-level, clinician-reported, measure of global disability, is the most widely employed outcome Scale in acute stroke trials. The Scale's original development preceded the advent of modern clinimetrics, but substantial subsequent work has been performed to enable the mRS to meet robust contemporary Scale standards. Prior research and consensus recommendations have focused on modernizing 2 aspects of the mRS: operationalized assignment of Scale scores and statistical analysis of Scale distributions. Another important characteristic of the mRS still requiring elaboration and specification to contemporary clinimetric standards is the Naming of Scale outcomes. Recent clinical trials have used a bewildering variety, often mutually contradictory, of rubrics to describe Scale states. Understanding of the meaning of mRS outcomes by clinicians, patients, and other clinical trial stakeholders would be greatly enhanced by use of a harmonized, uniform set of labels for the distinctive mRS outcomes that would be used consistently across trials. This statement advances such recommended rubrics, developed by the Stroke Therapy Academic Industry Roundtable collaboration using an iterative, mixed-methods process. Specific guidance is provided for health state terms (eg, Symptomatic but Nondisabled for mRS score 1; requires constant care for mRS score 5) and valence terms (eg, excellent for mRS score 1; very poor for mRS score 5) to employ for 23 distinct numeric mRS outcomes, including: all individual 7 mRS levels; all 12 positive and negative dichotomized mRS ranges, positive and negative sliding dichotomies; and utility-weighted analysis of the mRS.

  • intense arm rehabilitation therapy improves the Modified Rankin Scale score association between gains in impairment and function
    Neurology, 2021
    Co-Authors: Steven C. Cramer, Jeffrey L. Saver, Lucy Dodakian, Jill See, Renee Augsburger, Alison Mckenzie, Robert J Zhou, Nina L Chiu, Jutta Heckhausen, Jessica M Cassidy
    Abstract:

    Objective To evaluate the effect of intensive rehabilitation on the Modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains. Methods Patients were enrolled >90 days poststroke. Each was evaluated before and 30 days after a 6-week course of daily rehabilitation targeting the arm. Activity gains, measured using the mRS, were examined and compared to body structure/function gains, measured using the Fugl-Meyer (FM) motor Scale. Additional analyses examined whether activity gains were more strongly related to specific body structure/function gains. Results At baseline (160 ± 48 days poststroke), patients (n = 77) had median mRS score of 3 (interquartile range, 2–3), decreasing to 2 [2–3] 30 days posttherapy (p Conclusions Intensive arm motor therapy is associated with improved mRS in a substantial fraction (31.2%) of patients. Exploratory analysis suggests specific motor impairments that might underlie this finding and may be optimal targets for rehabilitation therapies that aim to reduce activities limitations. Clinical Trial Clinicaltrials.gov identifier: NCT02360488. Classification of Evidence This study provides Class III evidence that for patients >90 days poststroke with persistent arm motor deficits, intensive arm motor therapy improved mRS in a substantial fraction (31.2%) of patients.

  • abstract p233 descriptions of the meaning of Modified Rankin Scale outcomes in acute stroke clinical trials meta analysis and call to corrective action
    Stroke, 2021
    Co-Authors: Napasri Chaisinanunkul, Jeffrey L. Saver
    Abstract:

    Background: The Modified Rankin Scale, a 7-level, clinician-reported, measure of global disability, is the most widely employed outcome Scale in acute stroke trials. As the meaning of technical mRS...

  • the Rankin focused assessment ambulation a method to score the Modified Rankin Scale with emphasis on walking ability
    Journal of Stroke & Cerebrovascular Diseases, 2016
    Co-Authors: Sidney Starkman, Robin Conwit, Scott Hamilton, Richa Patel, Sharon Craig, Anna Grace, Jeffrey L. Saver
    Abstract:

    Background In the assessment of poststroke functional outcome, there are 2 alternative approaches to rating patient independence in motion: (1) focusing solely on patient ambulation (discounting self-use of wheelchair) and (2) focusing broadly on patient mobility (counting self-use of wheelchair). This study was undertaken to create and assess the inter-rater reliability of a version of the Rankin Focused Assessment (RFA) that focuses on ambulation (Rankin Focused Assessment—Ambulation [RFA-A]), as an alternative to the original RFA that focused on mobility (Rankin Focused Assessment—Mobility [RFA-M]). Methods The RFA-A was created by changing instructions in the RFA-M for handling of nonambulatory, wheelchair-using patients. Paired study coordinators then applied the RFA-A to 50 consecutive patients enrolled in a phase 3 acute stroke trial. Results Among the 50 patients, the mean age was 72 years (range 43-93) and 48% were female. Overall, study coordinator pairs assigned the same Modified Rankin Scale (mRS) grades to 48 of the 50 patients, yielding a weighted κ of .98 (95% confidence interval [CI] .96-1.00) and an unweighted κ of .95 (95% CI .89-1.02). At day 90, 43 patients were alive and 7 had died. Among surviving patients, the weighted κ was .98 (95% CI .95-1.00) and the unweighted κ was .94 (95% CI .86-1.02). The κ values for all 6 dichotomizations of the mRS score ranged from .93 to 1.00. Conclusions The RFA-A demonstrates high inter-rater reliability in grading global functional outcome. The RFA-A is a useful tool for assigning an mRS score in research and clinical practice when functional assessment focused on ambulation is desired.

  • Abstract W P328: Comparative Analysis of Two Methods to Score the Modified Rankin Scale: Rankin Focused Assessment and Simple Modified Rankin Scale Questionnaire
    Stroke, 2014
    Co-Authors: Richa D Patel, Sidney Starkman, Robin Conwit, Scott Hamilton, Fiona Chatfield, Jeffrey L. Saver
    Abstract:

    Background: The Modified Rankin Scale (mRS) of global disability is the most common primary endpoint in acute stroke clinical trials. Since intuitive scoring of the mRS yields only modest inter-rater reliability, more formal scoring methods, with improved reliability, have recently been developed, but little compared. Methods: The Rankin Focused Assessment (RFA) is a formally operationalized, rater-scoring method using all available data, including patient and caretaker reports, medical records, and direct patient exam. The simple Modified Rankin Scale questionnaire is a formally operationalized, patient report-based scoring method. We obtained 3 month mRS scores using the RFA and smRSq in consecutive patients enrolled in the NIH FAST-MAG trial. Results: Among 143 patients assessed at 3 months, the mean age was 66.9 (range 40-89+), 48.2% were female, and stroke subtype was ischemic in 70.6%. Amongst living patients, 3-month assessments were performed in person in 95% and by phone in 5%. With the RFA, mean...

Adnan I Qureshi - One of the best experts on this subject based on the ideXlab platform.

  • discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3 and 12 months among stroke survivors p07 014
    Neurology, 2012
    Co-Authors: Biggya L. Sapkota, Saqib A Chaudhry, Gustavo J. Rodriguez, M. Fareed K. Suri, Adnan I Qureshi
    Abstract:

    Objective: Analysis of the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. Post hoc analysis of patients recruited in a clinical trial. Background To determine the validity of discharge destination as a surrogate for defining favorable and unfavorable outcomes at 3 and 12 months and magnitude of under- or over-estimation of favorable and unfavorable outcomes. Design/Methods: A total of 530 patients were discharged alive from the hospital after ischemic stroke. Positive and negative predictive value and likelihood ratios of discharge destination for unfavorable outcome at 3 and 12 months defined by a Modified Rankin Scale (mRS) of 2-6, mRS 3-6, or mRS 4-6. We also evaluated the predictive value and likelihood ratios of discharge destination for unfavorable outcome at 3 and 12 months in two strata defined by age (≤65 years and >65 years). Results: The positive predictive value of discharge to nursing home/rehabilitation facility was the highest for unfavorable outcome defined by mRS 2-6 (90%), as compared with those defined by mRS of 3-6 (79%) and of 4-6 (57%). The positive likelihood ratio was high for unfavorable outcome defined by mRS 2-6 at 3 months (6.18, 95% CI 4.29-8.90). The likelihood ratio for unfavorable outcome (mRS 2-6) was higher among those aged ≤65 years (6.8, 95% CI 3.61-13) compared with those aged >65 years (5.73, 95% CI 3.67-8.95). Conclusions: Our results provide insight into the use of discharge destination as a surrogate measure for death and disability at 3 months as defined by mRS. Disclosure: Dr. Anderson has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Suri has nothing to disclose. Dr. Qureshi has nothing to disclose.

  • Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3- and 12-Months Poststroke Among Stroke Survivors
    Archives of physical medicine and rehabilitation, 2012
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Biggya L. Sapkota, Gustavo J. Rodriguez, M. Fareed K. Suri
    Abstract:

    Abstract Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MFK. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. Objective To determine the predictive value of discharge destination as a surrogate for defining unfavorable outcome at 3- and 12-months poststroke. Design Analysis of the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. Setting Post hoc analysis of patients recruited in a clinical trial. Participants Patients (N=530) discharged alive from the hospital after ischemic stroke. Interventions Not applicable. Main Outcome Measures Positive and negative predictive value and likelihood ratios of discharge destination for unfavorable outcome at 3- and 12-months poststroke defined by a Modified Rankin Scale (MRS) score of 2 to 6, 3 to 6, or 4 to 6. A likelihood ratio indicates how many times more (or less) likely a particular discharge destination is seen in patients with an unfavorable outcome compared with those without unfavorable outcome. Results The positive predictive value of nursing home and rehabilitation facility discharges was highest for unfavorable outcome defined by an MRS score of 2 to 6 (95%) and rehabilitation facility (89%) at 3-months poststroke, respectively. The positive predictive value of rehabilitation facility/nursing home (90%) was also highest for unfavorable outcomes defined by an MRS score of 2 to 6 compared with those defined by MRS scores of 3 to 6 (79%) and 4 to 6 (57%). The positive likelihood ratio was highest for nursing home discharges (13; 95% confidence interval [CI], 4.1–41) followed by rehabilitation facility discharges for unfavorable outcome defined by an MRS score of 2 to 6 at 3-months poststroke (5.3; 95% CI, 3.5–7.9). The negative likelihood ratio was the highest for home discharge for unfavorable outcome defined by an MRS score of 2 to 6 (4.5; 95% CI, 3.4–6.1). A similar pattern was observed with unfavorable outcome defined using various thresholds at 12 months. Conclusions Discharge destination can provide high predictive values and likelihood ratios for death and disability at 3-months poststroke, as defined by an MRS of score of 2 to 6.

  • abstract 3462 a novel web based Modified Rankin Scale program for certification and patient self assessment scoring in the antihypertensive treatment in acute cerebral hemorrhage atach ii trial
    Stroke, 2012
    Co-Authors: Rakesh Khatri, Bo Connelly, Saqib A Chaudhry, Erik Maland, Lawrence Algiers, Emily Abbott, Wodowossen G Tekle, Amir S Khan, Ameer E Hassan, Adnan I Qureshi
    Abstract:

    Background: The Modified Rankin Scale (mRS) is a commonly used disability Scale in clinical trials pertaining to acute stroke. Previous studies suggest that requiring the use of certification progr...

  • abstract 3701 a novel web based Modified Rankin Scale program for certification and patient self assessment scoring in the antihypertensive treatment in acute cerebral hemorrhage atach ii trial
    Stroke, 2012
    Co-Authors: Rakesh Khatri, Bo Connelly, Saqib A Chaudhry, Erik Maland, Emily Abbott, Wodowossen G Tekle, Amir S Khan, Ameer E Hassan, Adnan I Qureshi, Lawrence Algiers
    Abstract:

    Background: The Modified Rankin Scale (mRS) is a commonly used disability Scale in clinical trials pertaining to acute stroke. Previous studies suggest that requiring the use of certification progr...

Andrew M. Naidech - One of the best experts on this subject based on the ideXlab platform.

  • Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures
    Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2020
    Co-Authors: Robert L. Askew, Carmen E. Capo-lugo, Rajbeer S Sangha, Andrew M. Naidech, Shyam Prabhakaran
    Abstract:

    Abstract Introduction We aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by Modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure. Methods Mean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences. Results Seven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44). Conclusions Findings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.

  • abstract tp332 neuro qol measures have improved statistical power versus the dichotomized Modified Rankin Scale in stroke thrombolysis
    Stroke, 2016
    Co-Authors: Rajbeer S Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Ilana Ruff, Shyam Prabhakaran
    Abstract:

    Introduction: The Modified Rankin Scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-Q...

  • abstract tp332 neuro qol measures have improved statistical power versus the dichotomized Modified Rankin Scale in stroke thrombolysis
    Stroke, 2016
    Co-Authors: Rajbeer Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Ilana Ruff, Shyam Prabhakaran
    Abstract:

    Introduction: The Modified Rankin Scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL provide validated measures of patient-reported outcomes. In a matched case-control study, we hypothesized that differences in QOL in favor of tPA would be readily detectable compared to the dichotomous mRS outcome traditionally applied in acute stroke research. Methods: From a single-center prospective cohort study, we identified ischemic stroke patients who received intravenous tPA, admitted between August 1, 2012 and July 31, 2014, and who had 3-month QOL and mRS outcomes. Using a propensity score matching algorithm based on age and stroke severity, ischemic stroke patients who did not receive tPA were selected as controls. The mRS was assessed by structured telephone interviews and Neuro-QOL using short forms analyzing domains of upper extremity (UE), lower extremity (LE), executive function (EF), and general cognition (GC). T-scores for Neuro-QOL domains are referenced to the general population (mean 50, SD 10). We assessed differences in mRS (dichotomized 0-1 vs. 2-5) and QOL T-scores (continuous) in each domain using appropriate tests. Results: A total of 90 patients were analyzed (45 tPA and 45 controls; median NIHSS score 7). There was no statistical difference between the two groups by age (p=0.967) and NIHSS score (p=0.855). When comparing Neuro-QOL T-scores, higher scores were reported for domains of EF (tPA: 52 vs. controls: 46; p=0.032) and LE function (tPA: 46 vs. controls: 41; p=0.008) among tPA patients compared to controls. No differences were noted for UE or GC QOL T-scores. Using the mRS, the results were not statistically significant (dichotomous: 0-1, tPA: 75.6% vs. controls: 57.8%, p=0.117). Conclusion: Neuro-QOL offers a complementary tool for assessment of neurological function and may help identify finer grades of functional change and outcomes for stroke patients undergoing a specific therapy. The mRS requires a greater number of patients to show statistical significance while utilization of a continuous measurement of function from the patient perspective may improve statistical power in future clinical trials.

  • neuro qol for assessment of cognitive impairment after stroke comparison with Modified Rankin Scale p2 116
    Neurology, 2014
    Co-Authors: Rajbeer Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Deborah Bergman, Shyam Prabhakaran
    Abstract:

    OBJECTIVE: A comparison of Neuro-QOL: cognitive health domains with mRS in acute ischemic stroke BACKGROUND: The Modified Rankin Scale (mRS) is a reliable objective measure of disability which has been widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL acts as a continuous measurement of function from the patient perspective and provides validated measures of patient- reported outcomes. We compared QOL scores in cognitive health domains with mRS scores at 3 months after ischemic stroke or transient ischemic attack (TIA). Neuro- QOL measures included applied cognition - executive function (EF) and applied cognition - general concerns (GC). DESIGN/METHODS: From a single-center prospective cohort study, we identified ischemic stroke and TIA patients admitted between August 2012 and April 2013 who survived to 3-month follow-up and underwent mRS and Neuro-QOL outcomes assessments at 3 months. The mRS were assessed by structured telephone interviews and Neuro-QOL scores using short forms of executive function (EF) and general concerns (GC). We assessed the correlation between Neuro-QOL and mRS scores and evaluated the range of Neuro-QOL scores and identified mean T-scores in each mRS strata. RESULTS: Three-hundred twelve patients met study criteria (mean age 65.2 years; initial NIHSS score 4; 77.2% ischemic stroke). At 3 months, mean GC and EF T-scores were 53.5 (SD 7.7) and 51.3 (SD 10.5), respectively. Modest correlations were noted between mRS and cognitive function QOL T-scores at 3 months were mRS-EF: rs = -0.452 and mRS- GC: rs = -0.503. However, the range of T-scores was wide within mRS strata and correlation was non-linear. Among those with mRS 0-1, 19 of 252 patients (7.5%) had impaired Neuro-QOL GC or EF (> 1 SD below mean). CONCLUSIONS: The mRS correlates modestly but non-linearly with patient-reported scores of cognitive function using Neuro-QOL. Some patients report impairments in cognitive function despite no disability by mRS (i.e. 0-1). Therefore, Neuro-QOL provides a complementary tool for assessment of cognitive function after stroke. Disclosure: Dr. Sangha has nothing to disclose. Dr. Corado has nothing to disclose. Dr. Bergman has nothing to disclose. Dr. Naidech has received research support from Gaymar Inc. Dr. Cella has received personal compensation for activities with Moffit Caner Center. Dr. Bernstein has received personal compensation for activities with Boehringer Ingelheim Pharmaceuticals, Inc., and Pfizer Inc. Dr. Curran has nothing to disclose. Dr. Prabhakaran has received personal compensation for activities with American Heart Association.

  • abstract t p286 comparison of neuro qol physical function and Modified Rankin Scale in stroke
    Stroke, 2014
    Co-Authors: Rajbeer S Sangha, Andrew M. Naidech, Richard A Bernstein, David Cella, Carlos Corado, Yvonne Curran, Deborah Bergman, Shyam Prabhakaran
    Abstract:

    Introduction: The Modified Rankin Scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL provide validated measures of patient-reported outcomes. We compared changes in physical function QOL scores with transitions in mRS scores after ischemic stroke or transient ischemic attack (TIA). Methods: From a single-center prospective cohort study, we identified ischemic stroke and TIA patients admitted between August 2012 and April 2013 who survived to 3-month follow-up and underwent mRS and Neuro-QOL outcomes assessments at 1 and 3 months. The mRS was assessed by structured telephone interviews and Neuro-QOL scores using short forms of upper extremity (UE) and lower extremity (LE) function. We used Pearson9s coefficient to compare mRS and Neuro-QOL scores and assessed mean changes in Neuro-QOL T-scores across mRS strata and between 1 and 3 months. Results: Three-hundred twelve patients met study criteria (mean age 65.2 years; initial NIHSS score 4; 77.2% ischemic stroke). Strong correlations were noted between mRS and physical function QOL scores at 3-months: mRS-LE: r = -0.74; mRS-UE: r = -0.74. UE and LE QOL scores were 6.1 and 7.1 points lower, respectively, in those with mRS of 1 compared with 0. Within individual patients, a 1 point decrease (improvement) in mRS was associated with increase in UE and LE QOL by 5.6 and 3.3 points while a 1 point increase (worsening) in mRS was associated with a decrease in UE and LE QOL by 4.0 and 7.5 points, respectively. By mRS, 7.5% of patients had worsening by at least 1 point between 1 and 3 months while the proportion with at least 1 standard deviation (10 points) decrease in UE or LE QOL scores was 12.1% and 14.4%, respectively. Conclusions: The mRS correlates well with patient-reported scores of physical function using Neuro-QOL. However, Neuro-QOL offers a complementary tool for assessment of neurological function and may help identify finer grades of functional change over time. Using a continuous measurement of function from the patient perspective may also be more valuable to patients and improve statistical power in clinical trials.