Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment

Terence J Quinn, Martin Taylor-Rowan, Aisha Coyte, Allan Clark, Stanley Musgrave, Anthony Metcalf, Diana J Day, Max Bachmann, Elizabeth A Warburton, John Potter, Phyo K Myint

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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.
Original languageEnglish
Article number275
JournalFrontiers in Neurology
Publication statusPublished - 13 Jun 2017

Bibliographical note

The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute of Health Research (NIHR) for Patient Benefit Program (PB-PG-1208-18240). This paper presents independent research commissioned by the NIHR under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. TQ is supported by a Stroke Association/Chief Scientist Office Scotland Senior Clinical Lectureship. MT-R is jointly supported by Chest Heart and Scotland award and University of Glasgow bequest, his work is part of a Stroke Association/Chief Scientist Office program grant.


  • modified rankin
  • disability
  • stroke
  • outcome
  • complications
  • prognosis


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