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Terence J. Quinn - One of the best experts on this subject based on the ideXlab platform.

  • Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment.
    Frontiers in neurology, 2017
    Co-Authors: Terence J. Quinn, Martin Taylor-rowan, Aishah Coyte, Allan Clark, Stanley D. Musgrave, Anthony K. Metcalf, Diana J. Day, Max O Bachmann, Elizabeth A. Warburton, John F. Potter
    Abstract:

    Background and Purpose:The modified Rankin Scale (mRS) was designed to measure post-stroke recovery but is often used to describe pre-stroke disability. We sought to evaluate three aspects of pre-stroke mRS:validity as a measure of pre-stroke disability; prognostic accuracy and association of pre-stroke mRS scores and process of care. Methods:We used data from a large, UK clinical registry. For analysis of validity we compared pre-stroke mRS against other markers of pre-stroke function (age, comorbidity index, care needs). For analysis of prognostic accuracy we described univariable and multivariable models comparing pre-stroke mRS and other prognostic variables against a variety of outcomes (early and late mortality; length of stay; institutionalisation; incident complications). Finally, we described association of pre-stroke mRS and components of evidence-based stroke care (early neuroimaging, admission to stroke unit, assessment of swallow). Results:We analysed data of 2491 stroke patients. Concurrent validity analyses suggested statistically significant, but modest correlations between pre-stroke mRS and chosen variables (rho>0.40; p

  • pre stroke modified Rankin Scale evaluation of validity prognostic accuracy and association with treatment
    Frontiers in Neurology, 2017
    Co-Authors: Terence J. Quinn, Aishah Coyte, Allan Clark, Stanley D. Musgrave, Anthony K. Metcalf, Diana J. Day, Max O Bachmann, Elizabeth A. Warburton, Martin Taylorrowan, John F. Potter
    Abstract:

    Background and Purpose:The modified Rankin Scale (mRS) was designed to measure post-stroke recovery but is often used to describe pre-stroke disability. We sought to evaluate three aspects of pre-stroke mRS:validity as a measure of pre-stroke disability; prognostic accuracy and association of pre-stroke mRS scores and process of care. Methods:We used data from a large, UK clinical registry. For analysis of validity we compared pre-stroke mRS against other markers of pre-stroke function (age, comorbidity index, care needs). For analysis of prognostic accuracy we described univariable and multivariable models comparing pre-stroke mRS and other prognostic variables against a variety of outcomes (early and late mortality; length of stay; institutionalisation; incident complications). Finally, we described association of pre-stroke mRS and components of evidence-based stroke care (early neuroimaging, admission to stroke unit, assessment of swallow). Results:We analysed data of 2491 stroke patients. Concurrent validity analyses suggested statistically significant, but modest correlations between pre-stroke mRS and chosen variables (rho>0.40; p<0.0001 for all). Every point increase of pre-stroke mRS was associated with poorer outcomes for our prognostic variables (unadjusted p<0.001). This association held when corrected for other covariates. For example, pre-stroke mRS 4-5 OR:6.84 (95%CI:4.24-11.03) for one year mortality compared to mRS 0 in adjusted model. There was a difference between pre-stroke mRS and treatment, with higher pre-stroke mRS more likely to receive evidence based care. Conclusions:Results suggest that pre-stroke mRS has some concurrent validity and is a robust predictor of prognosis. This association is not explained by the influence of pre-stroke mRS on care pathways.

  • Understanding the relationship between costs and the modified Rankin Scale: A systematic review, multidisciplinary consensus and recommendations for future studies
    European stroke journal, 2016
    Co-Authors: Alastair Wilson, Terence J. Quinn, Philip M.w. Bath, Eivind Berge, Dominique A Cadilhac, Matthieu Cuche, Gary A. Ford, Rachael L. Macisaac, Matthew Taylor, Matthew Walters
    Abstract:

    Background and purpose: Cost-of-illness studies often describe a single aggregate cost of a disease state. This approach is less helpful for a condition with a spectrum of outcomes like stroke. The modified Rankin Scale is the most commonly used outcome measure for stroke. We sought to describe the existing evidence on the costs of stroke according to individual modified Rankin Scale categories. This may be useful in future cost effectiveness modelling studies of interventions where cost data have not been collected, but disability outcome is known. Methods: Systematic review of the published literature, searching electronic databases between 2004 and 2015 using validated search filters. Results were screened to identify studies presenting costs by individual modified Rankin Scale categories. Results: Of 17,782 unique identified articles, 13 matched all inclusion criteria. In only four of these studies were costs reported by modified Rankin Scale categories. Most studies included direct medical costs only. Societal costs were assessed in two studies. Overall, studies had a high methodological and reporting quality. The heterogeneity in costing methods used in the identified studies prevented meaningful comparison of the reported cost data. Despite this limitation, the costs consistently increased with greater severity (increasing modified Rankin Scale score). Conclusions: Few cost studies of stroke include information based on stroke recovery measured by individual modified Rankin Scale categories and the existing data are limited. To reliably capture this information, future studies are needed that preferably apply standardised costing methods to promote greater potential for use in cost-effectiveness analyses whereby direct collection of patient-level resource use has not been possible.

  • properties of proxy derived modified Rankin Scale assessment
    International Journal of Stroke, 2013
    Co-Authors: Kate Mcarthur, Michael L. C. Beagan, Andrew J. Degnan, Rosanne C. Howarth, Kirsten A. Mitchell, Fiona B. Mcquaige, Mary Ann C. Shannon, David J. Stott, Terence J. Quinn
    Abstract:

    BackgroundCognitive or communication issues may preclude direct modified Rankin Scale interview, necessitating interview with a suitable surrogate. The clinimetric properties of this proxy modified...

  • Properties of proxy‐derived modified Rankin Scale assessment
    International journal of stroke : official journal of the International Stroke Society, 2012
    Co-Authors: Kate Mcarthur, Michael L. C. Beagan, Andrew J. Degnan, Rosanne C. Howarth, Kirsten A. Mitchell, Fiona B. Mcquaige, Mary Ann C. Shannon, David J. Stott, Terence J. Quinn
    Abstract:

    BackgroundCognitive or communication issues may preclude direct modified Rankin Scale interview, necessitating interview with a suitable surrogate. The clinimetric properties of this proxy modified...

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: Junliang Yuan, Yunxiao Wang, 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 

  • 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.

  • The reliability and validity of a novel Chinese version simplified modified Rankin Scale questionnaire(2011)
    2020
    Co-Authors: Junliang Yuan, Yunxiao Wang, Askiel Bruno
    Abstract:

    Abstract Background 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. Methods 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. Results 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. Conclusions 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.

  • The reliability and validity of a slightly revised Chinese version simplified modified Rankin Scale questionnaire
    2019
    Co-Authors: Junliang Yuan, Yunxiao Wang, Askiel Bruno
    Abstract:

    Abstract Background: The slightly revised English version simplified modified Rankin Scale questionnaire smRSq(2011) was shown to be reliable, valid, and useful in scoring the modified Rankin Scale (mRS) after stroke. Our aim was to assess the inter-rater reliability and validity of a novel Chinese version smRSq(2011). Methods: 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. Results: 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 by the first rater and the conventional mRS scores by the second rater in each pair 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 by the first rater with the NIHSS and the BI scores by the second rater were 0.83 (P<0.001) and -0.86 (P<0.001), respectively. Conclusions: Our results suggest usefulness 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.

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

  • 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...

  • Intense Arm Rehabilitation Therapy Improves the Modified Rankin Scale Score
    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
    Abstract:

    ObjectiveTo 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.MethodsPatients 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.ResultsAt 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 < 0.0001). Similarly, the proportion of patients with mRS score ≤2 increased from 46.8% at baseline to 66.2% at 30 days posttherapy (p = 0.015). These findings were accounted for by the mRS score decreasing in 24 (31.2%) patients. Patients with a treatment-related mRS score improvement, compared to those without, had similar overall motor gains (change in total FM score, p = 0.63). In exploratory analysis, improvement in several specific motor impairments, such as finger flexion and wrist circumduction, was significantly associated with higher likelihood of mRS decrease.ConclusionsIntensive 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 TrialClinicaltrials.gov identifier: NCT02360488.Classification of EvidenceThis 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.

  • 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
    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 post-stroke. 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 post-stroke), patients (n=77) had median mRS score of 3 [IQR, 2 - 3], decreasing to 2 [2 - 3] 30-days post-therapy (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. Classification of Evidence: This study provides Class III evidence that for patients >90 days post-stroke with persistent arm motor deficits, intensive arm motor therapy improved mRS in a substantial fraction (31.2%) of patients.

  • 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...

  • Abstract TMP96: Development and Validation of a Certification Test for Scoring the Modified Rankin Scale Using the Rankin Focused Assessment
    Stroke, 2013
    Co-Authors: Jacqui Banzon, Sidney Starkman, Robin Conwit, Richa Patel, Nerses Sanossian, Molly Oswald, Jeffrey L. Saver
    Abstract:

    Background: The modified Rankin Scale is the most common primary endpoint in acute stroke clinical trials and is a new requirement for Comprehensive Stroke Center clinical practice. The Rankin Focu...

Kennedy R. Lees - One of the best experts on this subject based on the ideXlab platform.

  • Reliability of Structured Modified Rankin Scale Assessment
    Stroke, 2010
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kate Mcarthur, Kennedy R. Lees
    Abstract:

    To the Editor: The modified Rankin Scale (mRS) is the most prevalent stroke outcome assessment in clinical trials, yet literature describing the properties of the Scale remains limited,1 so we were pleased to see 2 papers describing clinometric assessment of mRS in the May issue of the Journal . Saver and colleagues describe a Rankin Focused Assessment Tool (RFAT),2 whereas Bruno’s group describes a simplified mRS questionnaire.3 The proposed use of structured assessment is in saving interviewers’ time and decreasing interobserver variability; both of these points are worthy of further discussion. The issue of time spent conducting mRS assessment is interesting. Based on collected data from 100 video-recorded, paired mRS interviews, we performed multivariate analysis to …

  • Reliability of the Modified Rankin Scale A Systematic Review
    Stroke, 2009
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kennedy R. Lees
    Abstract:

    Background and Purpose— A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies. Methods— Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus. Results— From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted κ=0.95 to κ=0.25. Overall reliability of mRS was κ=0.46; weighted κ=0.90 (traditional modified Rankin Scale) and κ=0.62; weighted κ=0.87 (structured interview). Conclusion— There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-Scale clinical trials demonstrate potentially significant interobserver variability.

  • Exploring the Reliability of the Modified Rankin Scale
    Stroke, 2009
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kennedy R. Lees
    Abstract:

    Background and Purpose— The modified Rankin Scale (mRS) is the most prevalent outcome measure in stroke trials. Use of the mRS may be hampered by variability in grading. Previous estimates of the properties of the mRS have used diverse methodologies and may not apply to contemporary trial populations. We used a mock clinical trial design to explore inter- and intraobserver variability of the mRS. Methods— Consenting patients with stroke attending for outpatient review had the mRS performed by 2 independent assessors with pairs of assessors selected from a team of 3 research nurses and 4 stroke physicians. Before formal assessment, interviewers estimated disability based only on initial patient observation. Each patient was then randomized to undergo the mRS using standard assessment or a prespecified structured interview. The second interviewer in the pair reassessed the patient using the same method blinded to the colleague’s score. For each patient assessed, one rater was randomly assigned to video reco...

  • Reliability of the Modified Rankin Scale
    Stroke, 2007
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kennedy R. Lees
    Abstract:

    Background and Purpose— A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies. Methods— Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus. Results— From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted κ=0.95 to κ=0.25. Overall reliability of mRS was κ=0.46; weighted κ=0.90 (traditional modified Rankin Scale) and κ=0.62; weighted κ=0.87 (structured interview). Conclusion— There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-Scale clinical trials demonstrate potentially significant in...

  • initial experience of a digital training resource for modified Rankin Scale assessment in clinical trials
    Stroke, 2007
    Co-Authors: Terence J. Quinn, Jesse Dawson, Kennedy R. Lees, Hansgoran Hardemark, Matthew Walters
    Abstract:

    Background and Purpose—The modified Rankin Scale (mRS) is the preferred measure of disability in cerebrovascular clinical trials, but its value is restricted by interobserver variability. Poor reliability reduces the statistical power of clinical trials and leads to underestimation of effect size. Strategies to improve mRS grading are required. Video training has previously improved application of the National Institutes of Health Stroke Scale in clinical research. We developed an mRS training resource in an attempt to minimize interobserver variability. Methods—We produced a complete training resource comprising an instructional DVD with accompanying written materials and assessment recordings of patient interviews. Formal assessment of training involved grading of real-life cases. Results of initial training and recertification were collected centrally and scored. Results—Data from 1564 assessments are presented. The majority of assessors were participating in 2 large prospective clinical stroke trials. Assessors represented a mixed group of disciplines and nationalities. After training, most trainees (90%) achieved certification in mRS assessment. The majority (85%) of investigators who did not reach an acceptable score on initial testing achieved certification after further exposure to the package. Conclusions—Mass training in mRS assessment for clinical trials is possible. We outline the development of a video-based training package, including technical issues, patient selection procedures, and methods of scoring and assessment. Certification results suggest that use of the resource can improve mRS grading. Acceptability of the training has been demonstrated by its successful use in 2 international acute stroke trials, SAINT 1 and CHANT. (Stroke. 2007;38:2257-2261.)

Matthew Walters - One of the best experts on this subject based on the ideXlab platform.

  • Understanding the relationship between costs and the modified Rankin Scale: A systematic review, multidisciplinary consensus and recommendations for future studies
    European stroke journal, 2016
    Co-Authors: Alastair Wilson, Terence J. Quinn, Philip M.w. Bath, Eivind Berge, Dominique A Cadilhac, Matthieu Cuche, Gary A. Ford, Rachael L. Macisaac, Matthew Taylor, Matthew Walters
    Abstract:

    Background and purpose: Cost-of-illness studies often describe a single aggregate cost of a disease state. This approach is less helpful for a condition with a spectrum of outcomes like stroke. The modified Rankin Scale is the most commonly used outcome measure for stroke. We sought to describe the existing evidence on the costs of stroke according to individual modified Rankin Scale categories. This may be useful in future cost effectiveness modelling studies of interventions where cost data have not been collected, but disability outcome is known. Methods: Systematic review of the published literature, searching electronic databases between 2004 and 2015 using validated search filters. Results were screened to identify studies presenting costs by individual modified Rankin Scale categories. Results: Of 17,782 unique identified articles, 13 matched all inclusion criteria. In only four of these studies were costs reported by modified Rankin Scale categories. Most studies included direct medical costs only. Societal costs were assessed in two studies. Overall, studies had a high methodological and reporting quality. The heterogeneity in costing methods used in the identified studies prevented meaningful comparison of the reported cost data. Despite this limitation, the costs consistently increased with greater severity (increasing modified Rankin Scale score). Conclusions: Few cost studies of stroke include information based on stroke recovery measured by individual modified Rankin Scale categories and the existing data are limited. To reliably capture this information, future studies are needed that preferably apply standardised costing methods to promote greater potential for use in cost-effectiveness analyses whereby direct collection of patient-level resource use has not been possible.

  • Reliability of Structured Modified Rankin Scale Assessment
    Stroke, 2010
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kate Mcarthur, Kennedy R. Lees
    Abstract:

    To the Editor: The modified Rankin Scale (mRS) is the most prevalent stroke outcome assessment in clinical trials, yet literature describing the properties of the Scale remains limited,1 so we were pleased to see 2 papers describing clinometric assessment of mRS in the May issue of the Journal . Saver and colleagues describe a Rankin Focused Assessment Tool (RFAT),2 whereas Bruno’s group describes a simplified mRS questionnaire.3 The proposed use of structured assessment is in saving interviewers’ time and decreasing interobserver variability; both of these points are worthy of further discussion. The issue of time spent conducting mRS assessment is interesting. Based on collected data from 100 video-recorded, paired mRS interviews, we performed multivariate analysis to …

  • Reliability of the Modified Rankin Scale A Systematic Review
    Stroke, 2009
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kennedy R. Lees
    Abstract:

    Background and Purpose— A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies. Methods— Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus. Results— From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted κ=0.95 to κ=0.25. Overall reliability of mRS was κ=0.46; weighted κ=0.90 (traditional modified Rankin Scale) and κ=0.62; weighted κ=0.87 (structured interview). Conclusion— There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-Scale clinical trials demonstrate potentially significant interobserver variability.

  • Exploring the Reliability of the Modified Rankin Scale
    Stroke, 2009
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kennedy R. Lees
    Abstract:

    Background and Purpose— The modified Rankin Scale (mRS) is the most prevalent outcome measure in stroke trials. Use of the mRS may be hampered by variability in grading. Previous estimates of the properties of the mRS have used diverse methodologies and may not apply to contemporary trial populations. We used a mock clinical trial design to explore inter- and intraobserver variability of the mRS. Methods— Consenting patients with stroke attending for outpatient review had the mRS performed by 2 independent assessors with pairs of assessors selected from a team of 3 research nurses and 4 stroke physicians. Before formal assessment, interviewers estimated disability based only on initial patient observation. Each patient was then randomized to undergo the mRS using standard assessment or a prespecified structured interview. The second interviewer in the pair reassessed the patient using the same method blinded to the colleague’s score. For each patient assessed, one rater was randomly assigned to video reco...

  • Reliability of the Modified Rankin Scale
    Stroke, 2007
    Co-Authors: Terence J. Quinn, Jesse Dawson, Matthew Walters, Kennedy R. Lees
    Abstract:

    Background and Purpose— A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies. Methods— Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus. Results— From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted κ=0.95 to κ=0.25. Overall reliability of mRS was κ=0.46; weighted κ=0.90 (traditional modified Rankin Scale) and κ=0.62; weighted κ=0.87 (structured interview). Conclusion— There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-Scale clinical trials demonstrate potentially significant in...