Rangaraju S, Haussen D, Nogueira RG, Nahab F, Frankel M (2017) Comparison of 3-month stroke disability and quality of life across modified Rankin Scale categories. Interventional Neurology, 6, 36-41. https://doi.org/10.1159/000452634
Background and Purpose: Modified Rankin Scale (mRS) score 0-2 has been used to define “good outcome” while stroke patients with mRS 3 are grouped with mRS 4-6 as having “poor outcome.” Long-term data comparing quality of life (QoL), particularly across the mRS 2, 3, and 4 subgroups, are sparse.
Methods: Participants in the Interventional Management of Stroke 3 (IMS3) trial with documented 3-month mRS, functional disability (Barthel index [BI]), and self-reported EQ5D-3L QoL questionnaires at 3 months after stroke were included. EQ5D-3L summary indices were calculated using published utility weights for the US population. BI and EQ5D-3L indices were compared across mRS categories using multiple pairwise comparisons with appropriate alpha error corrections.
Results: Four hundred twenty-three patients were included (mean age 64 ± 13 years, median baseline NIHSS 16 [IQR 12-19], mean BI 84.1 ± 25.3, and mean EQ5D-3L index 0.73 ± 0.24). While significant differences in BI were observed across mRS categories, QoL in the mRS 2 and 3 categories was similar. Based on BI and EQ5D-3L index, mRS 3 status was more similar to mRS 2 than to mRS 4 status, and large heterogeneity in the mRS 3 group was observed.
Conclusions: Ischemic stroke patients who achieve mRS 2 and 3 functional outcomes seem to have similar health-related QoL scores. mRS 0-3, rather than 0-2, should be considered a good outcome category in moderate to severe ischemic stroke.
When are we going to start routinely and consistently measuring outcomes over time in those affected by stroke? Why aren’t we already doing this? If its because it takes too much time, then here’s evidence about a “blink-of-an-eye” stroke assessment; the modified Rankin Score or mRS. It is a standardised, valid and reliable assessment that can measure recovery after stroke. It takes no expertise or practice, and its completely free! If you’re using nothing else, then this is a worthwhile “starter” when it comes to measuring outcomes.
At least, when you use the mRS, you can be sure you’re measuring what you think you’re measuring. If you’re using an outcome measure that’s not standardised, then you cannot be sure of anything. Almost all “initial assessments” are non-standardised, and so too are all assessments or screens developed by a particular department or facility; irrespective of whether or not they’ve been “endorsed” by others. Using non-standardised assessments is like handing over Monopoly money when you go to purchase your morning coffee! This seems like such a ridiculous idea – and yet, we seem to be quite prepared to do this to those who have been directly affected by stroke.
Anyway, I digress, which, for those of you who know me, will know is far too easy for me to do!! What’s interesting about the findings of this study is that an mRS of 3 is not as much of a threat to a person’s quality of life as was previously assumed. In patients and clients who are less than 3 months post-ischemic stroke, this evidence indicates an mRS of 1, 2 or 3 is worth considering as a “good” outcome in relation to that person’s quality of life.
As always, this is just my “humble opinion”, or perhaps, in this case, “rant”. As always, this article is well worth reading and provides impetus to start recording the mRS over time in those with stroke, if you’re not using any other standardised assessments at all.
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