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Modified Rankin Scale (mRS)

Reference descriptions for the modified Rankin Scale of disability after stroke.

For healthcare professionalsNeurologyv1.0.1

For healthcare professionals / clinical use. Not a self-diagnosis tool.

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Methodology

Modified Rankin Scale (van Swieten 1988)

Ordinal 0–6

The standard outcome measure in stroke trials. Structured interviews improve agreement between raters. van Swieten and colleagues (1988) measured agreement between observers on grades 0–5; grade 6 is used for death.

Who it is for
Adults after stroke or other neurological illness.
Version
1.0.1

How this calculator works

Where the formula comes from

  • van Swieten and colleagues (1988) studied interobserver agreement on the modified Rankin Scale in 100 stroke patients using six grades (0–5); kappa was 0.56 and weighted kappa 0.91.[1]

Versions and alternatives

  • With many raters, agreement was 43% (kappa 0.25) on the conventional scale and 81% (kappa 0.74) with a structured interview.[2]

Where accuracy falls (published evidence)

  • A 2009 systematic review (10 studies, 587 patients) found reliability ranging from kappa 0.25 to weighted kappa 0.95, with overall kappa 0.46 for the traditional scale and 0.62 with a structured interview.[3]

What guidelines say

  • A 2007 review describes the mRS as widely used as an end point in stroke trials; inter-rater reliability was moderate and improved with structured interviews (kappa 0.56 vs 0.78).[4]

Sources

  1. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–607. doi:10.1161/01.STR.19.5.604
  2. Wilson JT, Hareendran A, Hendry A, et al. Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke. 2005;36(4):777–781. doi:10.1161/01.STR.0000157596.13234.95
  3. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009;40(10):3393–3395. doi:10.1161/STROKEAHA.109.557256
  4. Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091–1096. doi:10.1161/01.STR.0000258355.23810.c6

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate modified Rankin

Inputs

Grade
3 — Moderate disability; requiring some help, but able to walk without assistance

Result

mRS grade
3

Moderate disability; requiring some help, but able to walk without assistance

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Inter-rater variability is substantial without a structured interview.

References

  1. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–607. doi:10.1161/01.STR.19.5.604

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