Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Stroke. 2009 Dec;40(12):3828-33. doi: 10.1161/STROKEAHA.109.561365. Epub 2009 Oct 1.
The modified Rankin Scale (mRS) categorizes poststroke disability among 7 broad, ordinal grades, but the interval distances between these levels are spaced along the disability spectrum have not been previously investigated.
We used the person trade-off procedure developed by the World Health Organization Global Burden of Disease Project (WHO-GBDP) to generate disability weights (DWs) ranging from 0 (normal) to 1 (dead) for each of 7 mRS grades. The ratings of an international, 9-member panel of stroke experts were combined by a modified Delphi process.
DWs (95% CI) were 0 for mRS 0, 0.046 (0.004 to 0.088) for mRS 1, 0.212 (0.175 to 0.250) for mRS 2, 0.331 (0.292 to 0.371) for mRS 3, 0.652 (0.625 to 0.678) for mRS 4, 0.944 (0.873 to 1.015) for mRS 5, and 1.0 for mRS 6. DWs of adjacent mRS levels were significantly different (P<0.001 for all). Coefficients of variation showed a high degree of consensus for DWs among panel members. DWs placed each of the 5 intermediate mRS states in different disability class levels of the WHO-GBDP anchor conditions and identified natural clusters to use when reducing the mRS to fewer categories.
Formal DW assignment confirms that the mRS is an ordered but unequally spaced scale. The availability of DWs for each mRS level now permits direct comparison of each poststroke outcome state with the outcomes of hundreds of other diseases in the WHO-GBDP and the expression of stroke burden in different populations by using the uniform metric of disability-adjusted life-years lost.
改良 Rankin 量表（mRS）将脑卒中后残疾分为 7 个广泛的有序等级，但这些水平之间的间隔距离沿残疾谱分布尚未得到研究。
我们使用世界卫生组织全球疾病负担项目（WHO-GBDP）开发的个人权衡程序，为 7 个 mRS 等级中的每个等级生成残疾权重（DW），范围从 0（正常）到 1（死亡）。国际 9 人卒中专家小组的评分通过改良 Delphi 程序进行组合。
DW（95%CI）为 mRS 0 为 0，mRS 1 为 0.046（0.004 至 0.088），mRS 2 为 0.212（0.175 至 0.250），mRS 3 为 0.331（0.292 至 0.371），mRS 4 为 0.652（0.625 至 0.678），mRS 5 为 0.944（0.873 至 1.015），mRS 6 为 1.0。相邻 mRS 水平的 DW 显著不同（所有 P<0.001）。变异系数显示，小组成员对 DW 具有高度共识。DW 将 5 个中间 mRS 状态分别置于 WHO-GBDP 锚定条件的不同残疾等级中，并确定了在减少 mRS 类别时使用的自然聚类。
正式的 DW 赋值证实 mRS 是一个有序但不等距的量表。现在，每个 mRS 水平的 DW 都可以直接比较每个脑卒中后结局状态与 WHO-GBDP 中数百种其他疾病的结局，并使用丧失的残疾调整生命年来表达不同人群的脑卒中负担。
