0 No symptoms
1 No significant disability Has symptoms, but able to carry out all usual duties and activities
2 Slight disability Unable to carry out all previous activities, but able to look after own affairs without assistance.
3 Moderate disability
Requiring some help, but able to walk without assistance.
4 Moderately severe disability
Unable to walk without assistance, and unable to attend own bodily needs without assistance.
5 Severe disability
Bedridden, incontinent, and requiring constant nursing care and attention
The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability, and it has become the most widely used clinical outcome measure for stroke clinical trials. It was originally introduced in 1957 by Dr. John Rankin of Stobhill Hospital Glasgow, Scotland and first modified to its currently accepted form by Prof. C. Warlow's group at Western General Hospital in Edinburgh for use in the UK-TIA study in the late 1980s.
The first publication of the current modified Rankin Scale was in 1988 by van Swieten, et al., who also published the first interobserver agreement analysis of the modified Rankin Scale.
Interobserver reliability of the mRS can be improved by using a structured questionnaire during the interview process and by having raters undergo a multimedia training process.
The multimedia mRS training system developed by Prof. K. Lees' group at the University of Glasgow is available online.
More recently, several tools have been developed to more systematically determine the mRS, including the mRS-SI,the RFA, and the mRS-9Q.
The mRS-9Q is in the public domain and a free web calculator is available at www.modifiedrankin.com.
The Modified Rankin Scale (mRS)
The scale runs from 0-6, running from perfect health without symptoms to death. 0 - No symptoms. 1 - No significant disability. Able to carry out all usual activities, despite some symptoms. 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities. 3 - Moderate disability. Requires some help, but able to walk unassisted. 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted. 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent. 6 - Dead.
Barthel scale Cincinnati Stroke Scale (just for diagnosis of stroke)
Rankin J (May 1957). “Cerebral vascular accidents in patients over the age of 60. II. Prognosis”. Scott Med J 2 (5): 200–15. PMID 13432835.
Farrell B, Godwin J, Richards S, Warlow C, et al. (1991). “The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results.”. J Neurol Neurosurg Psychiatry 54 (12): 1044–1054. doi:10.1136/jnnp.54.12.1044. PMC 1014676. PMID 1783914.
van Swieten J, Koudstaal P, Visser M, Schouten H, et al. (1988). “Interobserver agreement for the assessment of handicap in stroke patients.”. Stroke 19 (5): 604–607. PMID 3363593.
Wilson JL, Hareendran A, Grant M, et al. (2002). “Improving the Assessment of Outcomes in Stroke: Use of a Structured Interview to Assign Grades on the Modified Rankin Scale.”. Stroke 33 (9): 2243–2246. doi:10.1161/01.STR.0000027437.22450.BD. PMID 12215594.
Wilson JL, Hareendran A, Hendry A, et al. (2005). “Reliability of the Modified Rankin Scale Across Multiple Raters: Benefits of a Structured Interview.”. Stroke 36 (4): 777–781. doi:10.1161/01.STR.0000157596.13234.95. PMID 15718510.
Quinn TJ, Lees KR, Hardemark HG, et al. (2007). “Initial experience of a digital training resource for modified Rankin scale assessment in clinical trials.”. Stroke 38 (8): 2257–2261. doi:10.1161/STROKEAHA.106.480723. PMID 17600236.
Bruno A, Shah N, Lin C, “et al.” (2010). “Improving modified Rankin Scale assessment with a simplified questionnaire”. Stroke 41 (5): 1048–50. doi:10.1161/STROKEAHA.109.571562. PMID 20224060.
Saver JL, Filip B, Hamilton S, “et al.” (2010). “Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA)”. Stroke 41 (5): 992–95. doi:10.1161/STROKEAHA.109.571364. PMC 2930146. PMID 20360551.
Patel N, Rao VA, Heilman-Espinoza ER, Lai R, Quesada RA, Flint AC (July 2012). “Simple and reliable determination of the modified Rankin Scale in neurosurgical and neurological patients: The mRS-9Q”. Neurosurgery 71 (5): 971–5; discussion 975. doi:10.1227/NEU.0b013e31826a8a56. PMID 22843133.