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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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.
Original languageEnglish
Article number275
JournalFrontiers in Neurology
Volume8
DOIs
Publication statusPublished - 13 Jun 2017

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Stroke
Therapeutics
Institutionalization
Mortality
Deglutition
Neuroimaging
Registries
Comorbidity
Length of Stay

Keywords

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

Cite this

Pre-Stroke Modified Rankin Scale : Evaluation of Validity, Prognostic Accuracy, and Association with Treatment. / Quinn, Terence J; Taylor-Rowan, Martin ; Coyte, Aisha ; Clark, Allan; Musgrave, Stanley; Metcalf, Anthony; Day, Diana J; Bachmann, Max; Warburton, Elizabeth A; Potter, John; Myint, Phyo K.

In: Frontiers in Neurology, Vol. 8, 275, 13.06.2017.

Research output: Contribution to journalArticle

Quinn, TJ, Taylor-Rowan, M, Coyte, A, Clark, A, Musgrave, S, Metcalf, A, Day, DJ, Bachmann, M, Warburton, EA, Potter, J & Myint, PK 2017, 'Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment', Frontiers in Neurology, vol. 8, 275. https://doi.org/10.3389/fneur.2017.00275
Quinn, Terence J ; Taylor-Rowan, Martin ; Coyte, Aisha ; Clark, Allan ; Musgrave, Stanley ; Metcalf, Anthony ; Day, Diana J ; Bachmann, Max ; Warburton, Elizabeth A ; Potter, John ; Myint, Phyo K. / Pre-Stroke Modified Rankin Scale : Evaluation of Validity, Prognostic Accuracy, and Association with Treatment. In: Frontiers in Neurology. 2017 ; Vol. 8.
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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.",
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author = "Quinn, {Terence J} and Martin Taylor-Rowan and Aisha Coyte and Allan Clark and Stanley Musgrave and Anthony Metcalf and Day, {Diana J} and Max Bachmann and Warburton, {Elizabeth A} and John Potter and Myint, {Phyo K}",
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.",
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TY - JOUR

T1 - Pre-Stroke Modified Rankin Scale

T2 - Evaluation of Validity, Prognostic Accuracy, and Association with Treatment

AU - Quinn, Terence J

AU - Taylor-Rowan, Martin

AU - Coyte, Aisha

AU - Clark, Allan

AU - Musgrave, Stanley

AU - Metcalf, Anthony

AU - Day, Diana J

AU - Bachmann, Max

AU - Warburton, Elizabeth A

AU - Potter, John

AU - Myint, Phyo K

N1 - 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.

PY - 2017/6/13

Y1 - 2017/6/13

N2 - 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.

AB - 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.

KW - modified rankin

KW - disability

KW - stroke

KW - outcome

KW - complications

KW - prognosis

U2 - 10.3389/fneur.2017.00275

DO - 10.3389/fneur.2017.00275

M3 - Article

VL - 8

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

M1 - 275

ER -