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Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment
BACKGROUND AND PURPOSE: The modified Rankin Scale (mRS) was designed to measure poststroke 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-s...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468801/ https://www.ncbi.nlm.nih.gov/pubmed/28659859 http://dx.doi.org/10.3389/fneur.2017.00275 |
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author | Quinn, Terence J. Taylor-Rowan, Martin Coyte, Aishah Clark, Allan B. Musgrave, Stanley D. Metcalf, Anthony K. Day, Diana J. Bachmann, Max O. Warburton, Elizabeth A. Potter, John F. Myint, Phyo Kyaw |
author_facet | Quinn, Terence J. Taylor-Rowan, Martin Coyte, Aishah Clark, Allan B. Musgrave, Stanley D. Metcalf, Anthony K. Day, Diana J. Bachmann, Max O. Warburton, Elizabeth A. Potter, John F. Myint, Phyo Kyaw |
author_sort | Quinn, Terence J. |
collection | PubMed |
description | BACKGROUND AND PURPOSE: The modified Rankin Scale (mRS) was designed to measure poststroke 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, institutionalization, 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 analyzed data of 2,491 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 odds ratio (OR): 6.84 (95% CI: 4.24–11.03) for 1 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. CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-5468801 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-54688012017-06-28 Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment Quinn, Terence J. Taylor-Rowan, Martin Coyte, Aishah Clark, Allan B. Musgrave, Stanley D. Metcalf, Anthony K. Day, Diana J. Bachmann, Max O. Warburton, Elizabeth A. Potter, John F. Myint, Phyo Kyaw Front Neurol Neuroscience BACKGROUND AND PURPOSE: The modified Rankin Scale (mRS) was designed to measure poststroke 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, institutionalization, 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 analyzed data of 2,491 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 odds ratio (OR): 6.84 (95% CI: 4.24–11.03) for 1 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. CONCLUSION: 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. Frontiers Media S.A. 2017-06-13 /pmc/articles/PMC5468801/ /pubmed/28659859 http://dx.doi.org/10.3389/fneur.2017.00275 Text en Copyright © 2017 Quinn, Taylor-Rowan, Coyte, Clark, Musgrave, Metcalf, Day, Bachmann, Warburton, Potter and Myint. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neuroscience Quinn, Terence J. Taylor-Rowan, Martin Coyte, Aishah Clark, Allan B. Musgrave, Stanley D. Metcalf, Anthony K. Day, Diana J. Bachmann, Max O. Warburton, Elizabeth A. Potter, John F. Myint, Phyo Kyaw Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment |
title | Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment |
title_full | Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment |
title_fullStr | Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment |
title_full_unstemmed | Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment |
title_short | Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment |
title_sort | pre-stroke modified rankin scale: evaluation of validity, prognostic accuracy, and association with treatment |
topic | Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468801/ https://www.ncbi.nlm.nih.gov/pubmed/28659859 http://dx.doi.org/10.3389/fneur.2017.00275 |
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