Tvrda Lucie, Mavromati Kalliopi, Taylor-Rowan Martin, Quinn Terence J
School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Eur Stroke J. 2024 Oct 30:23969873241293569. doi: 10.1177/23969873241293569.
The Modified Rankin Scale (mRS) is the most commonly used functional measure in stroke research but is limited by inter-rater reliability (IRR). Various interventions to improve mRS application have been described. We aimed to compare properties of differing approaches to mRS assessment.
Multidisciplinary databases (MEDLINE, EMBASE, Health and Psychosocial Instruments [OVID], CINAHL, PsycINFO [EBSCO]) were searched for adult human stroke studies describing psychometric properties of mRS. Two researchers independently screened 20% titles and abstracts, reviewed all full studies, extracted data, and conducted risk of bias (ROB) analysis. Primary outcomes for random-effects meta-analysis were IRR measured by kappa (K) and weighted kappa (KW). Validity and inter-modality reliability measures (Spearman's rho, KW) were also summarised.
From 897 titles, 46 studies were eligible, including twelve differing approaches to mRS, 8608 participants. There was high ROB in 14 (30.4%) studies. Overall, reliability was substantial ( = 29 studies, = 0.65, 95% CI: 0.58-0.71) but IRR was higher for novel approaches to mRS, for example, the Rankin Focussed Assessment ( = 2 studies, = 0.94, 95% CI: 0.90-0.98) than standard mRS ( = 13 studies, = 0.55, 95%CI:0.46-0.64). Reliability improved following the introduction of mRS training ( = 0.56, 95% CI: 0.44-0.67; vs = 0.69, 95% CI: 0.62-0.77). Validity ranged from poor to excellent, with an excellent overall concurrent validity of novel scales ( = 6 studies, KW = 0.86, 95% CI: 0.75-0.97). The agreement between face-to-face and telephone administration was substantial ( = 5 studies, KW = 0.80, 95% CI: 0.74-0.87).
The mRS is a valid measure of function but IRR remains an issue. The present findings are limited by a high ROB and possible publication bias.
Interventions to improve mRS reliability (training, structured interview, adjudication) seem to be beneficial, but single interventions do not completely remove reliability concerns.
改良Rankin量表（mRS）是卒中研究中最常用的功能评估工具，但受评分者间信度（IRR）的限制。已有多种改善mRS应用的干预措施被描述。我们旨在比较不同mRS评估方法的特性。
检索多学科数据库（MEDLINE、EMBASE、健康与心理社会测量工具[OVID]、CINAHL、PsycINFO[EBSCO]），查找描述mRS心理测量特性的成人心源性卒中研究。两名研究人员独立筛选20%的标题和摘要，审阅所有完整研究，提取数据，并进行偏倚风险（ROB）分析。随机效应荟萃分析的主要结局是用kappa（K）和加权kappa（KW）测量的IRR。还总结了效度和不同评估方式间的信度指标（Spearman相关系数、KW）。
从897个标题中，筛选出46项研究，包括12种不同的mRS评估方法，8608名参与者。14项（30.4%）研究存在高ROB。总体而言，信度较高（n = 29项研究， = 0.65，95%CI：0.58 - 0.71），但mRS的新方法的IRR更高，例如，Rankin重点评估法（n = 2项研究， = 0.94，95%CI：0.90 - 0.98）高于标准mRS（n = 13项研究， = 0.55，95%CI：0.46 - 0.64）。引入mRS培训后信度有所提高（ = 0.56，95%CI：0.44 - 0.67；vs = 0.69，95%CI：0.62 - 0.77）。效度从差到优不等，新量表的总体同时效度极佳（n = 6项研究，KW = 0.86，95%CI：0.75 - 0.97）。面对面评估和电话评估之间的一致性较高（n = 5项研究，KW = 0.80，95%CI：0.74 - 0.87）。
mRS是一种有效的功能评估工具，但IRR仍然是一个问题。目前的研究结果受到高ROB和可能的发表偏倚的限制。
改善mRS信度的干预措施（培训、结构化访谈、裁定）似乎是有益的，但单一干预措施并不能完全消除对信度的担忧。
