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Simple and Reliable Determination of the Modified Rankin Scale Score in Neurosurgical and Neurological Patients: The mRS-9Q

Patel, Nihar BA; Rao, Vivek A. MD; Heilman-Espinoza, Elizabeth R. MD; Lai, Raymond DO; Quesada, Ramon A. MD; Flint, Alexander C. MD, PhD

doi: 10.1227/NEU.0b013e31826a8a56
Research-Human-Clinical Studies

BACKGROUND: The modified Rankin Scale (mRS) is a 6-level outcome scale used to assess level of function in neurological disease.

OBJECTIVE: We examined the interobserver reliability and intraobserver reliability of the mRS-9Q, a 9-question “yes/no” survey that measures the mRS score in neurosurgical and neurological patients.

METHODS: The mRS-9Q was administered in person or by telephone, and a Web-based tool was used to calculate the mRS score and to perform error checking. Part 1 compared the mRS-9Q with an mRS structured interview (n = 80). Part 2 compared mRS-9Q administration by telephone and by hard copy (n = 80). Part 3 compared mRS-9Q administration by an expert interviewer with administration by a nonexpert (n = 83). Part 4 examined reproducibility of the mRS-9Q over a 2-week period (n = 84).

RESULTS: Agreement was very good in all study parts. In Part 1 (mRS-9Q vs mRS with structured interview), κ = 0.80 and κw = 0.96. In Part 2 (mRS-9Q telephone vs hard copy), κ = 0.83 and κw = 0.95. In Part 3 (mRS-9Q expert vs nonexpert), κ = 0.73 and κw = 0.93. In Part 4 (mRS-9Q reproducibility), κ = 0.76 and κw = 0.93.

CONCLUSION: The mRS-9Q is a simple, easy-to-administer survey with a custom Web-based mRS calculation and error-checking tool. The mRS-9Q can reliably determine the mRS by hard copy survey or by telephone and can be administered by experts or nonmedical study personnel. The mRS-9Q can be used to measure functional outcome in a broad population of patients with neurosurgical and neurological diseases.

ABBREVIATIONS: CI, confidence interval

mRS, modified Rankin Scale

mRS-SI, modified Rankin Scale structured expert interview

smRSq, simplified mRS questionnaire

Department of Neuroscience, Kaiser Permanente, Redwood City, California

Correspondence: Alexander C. Flint, MD, PhD, Department of Neuroscience, Kaiser Permanente, 1150 Veterans Blvd., Redwood City, CA 94063. E-mail:

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Received April 4, 2012

Accepted July 5, 2012

Copyright © by the Congress of Neurological Surgeons