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Subject of the scale: Traumatic brain injury, coma, stroke

Modified Rankin Scale


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A hetero-type scale for an assessment of the handicap after a cerebral-vascular incident.

This consists of a tool with 6 items going from 0 (no handicap) to 5 (major handicap), permanent confinement, incontinence and permanent nursing care).

The time of this is very short.

> Access to the scale is free

Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity


Predictive validity


Construct validity

Convergent validity

[4] [5] [6] [8] [9] [12] [13] [14]

Divergent validity


Discriminant validity
(sensitivity and distinctiveness)



Intra-rater reliability

[4] [15] [17]

Inter-rater reliability

[3] [10] [11] [15] [16] [17] [18] [19] [20] [21]


[15] [16]

Internal consistency (alpha)




General comment on reliability:

The inter-judge reproducibility seems better if the assessment is coupled with a semi-structured conversation [10, 15, 22]. The convergence validity has been assessed by comparing it to the scales of disability and particularly the Barthel index. There is no specific corollary scale predictive of the handicap after a cerebral-vascular incident but sometimes this is compared to a disability scale: the Barthel scale.

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More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. François GENET :


Inaugural references:

[1] Rankin L. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2:200-215.

[2] Uyttenboogaart M, Stewart RE, Vroomen PC, De KJ, Luijckx GJ. Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials. Stroke. 2005 Sep;36(9):1984-7. Epub 2005 Aug 4.

Psychometric references:

[3] van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604-7.

[4] Wolfe CD, Taub NA, Woodrow EJ, Burney PG. Assessment of scales of disability and handicap for stroke patients. Stroke. 1991 Oct;22(10):1242-4.

[5] Lai SM, Duncan PW. Evaluation of the American Heart Association Stroke Outcome Classification. Stroke. 1999 Sep;30(9):1840-3.

[6] Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999 Oct;30(10):2131-40.

[7] Dawson SL, Manktelow BN, Robinson TG, Panerai RB, Potter JF. Which parameters of beat-to-beat blood pressure and variability best predict early outcome after acute ischemic stroke? Stroke. 2000 Feb;31(2):463-8.

[8] Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of functional outcome, survival, and recurrence. Stroke. 2000 May;31(5):1062-8.

[9] Lai SM, Duncan PW. Stroke recovery profile and the Modified Rankin assessment. Neuroepidemiology. 2001 Feb;20(1):26-30.

[10] Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, Bone I. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke. 2002 Sep;33(9):2243-6.

[11] Newcommon NJ, Green TL, Haley E, Cooke T, Hill MD. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke. 2003 Feb;34(2):377-8; author reply 377-8.

[12] Lai SM, Perera S, Duncan PW, Bode R. Physical and social functioning after stroke: comparison of the Stroke Impact Scale and Short Form-36. Stroke. 2003 Feb;34(2):488-93.

[13] Parmigiani G, Ashih HW, Samsa GP, Duncan PW, Lai SM, Matchar DB. Cross-calibration of stroke disability measures: Bayesian analysis of longitudinal ordinal categorical data using negative dependence. J Am Stat Assoc. 2003;98:273-281.

[14] Kwon S, Hartzema AG, Duncan PW, Min-Lai S. Disability measures in stroke: relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke. 2004;35:918-923.

[15] Wilson JT, Hareendran A, Hendry A, Potter J, Bone I, Muir KW. Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke. 2005 Apr;36(4):777-81. Epub 2005 Feb 17.

[16] 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 Mar;38(3):1091-6. Epub 2007 Feb 1.

[17] Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale. Stroke. 2007 Nov;38(11):e144; author reply e145. Epub 2007 Sep 20. No abstract available.

[18] Quinn TJ, Dawson J, Walters MR, Lees KR. Variability in modified Rankin scoring across a large cohort of international observers. Stroke. 2008 Nov;39(11):2975-9. doi: 10.1161/STROKEAHA.108.515262. Epub 2008 Aug 7.

[19] Quinn TJ, Dawson J, Walters MR, Lees KR. Exploring the reliability of the modified rankin scale. Stroke. 2009 Mar;40(3):762-6. doi: 10.1161/STROKEAHA.108.522516. Epub 2009 Jan 8.

[20] Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009 Oct;40(10):3393-5. doi: 10.1161/STROKEAHA.109.557256. Epub 2009 Aug 13. Review.

[21] Quinn TJ, McArthur K, Dawson J, Walters MR, Lees KR. Reliability of structured modified rankin scale assessment. Stroke. 2010 Dec;41(12):e602; author reply e603. doi: 10.1161/STROKEAHA.110.590 547. Epub 2010 Oct 28. No abstract available.

[22] Bruno A, Akinwuntan AE, Lin C, Close B, Davis K, Baute V, Aryal T, Brooks D, Hess DC, Switzer JA, Nichols FT. Simplified modified rankin scale questionnaire: reproducibility over the telephone and validation with quality of life. Stroke. 2011 Aug;42(8):2276-9. doi: 10.1161/STROKEAHA.111.613273. Epub 2011 Jun 16.

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