Comparing the properties of traditional and novel approaches to the modified Rankin scale: Systematic review and meta-analysis.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-10-30 DOI:10.1177/23969873241293569

Lucie Tvrda, Kalliopi Mavromati, Martin Taylor-Rowan, Terence J Quinn

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引用次数: 0

Abstract

Introduction: 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.

Patients and methods: 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.

Results: 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 (n = 29 studies, K = 0.65, 95% CI: 0.58-0.71) but IRR was higher for novel approaches to mRS, for example, the Rankin Focussed Assessment (n = 2 studies, K = 0.94, 95% CI: 0.90-0.98) than standard mRS (n = 13 studies, K = 0.55, 95%CI:0.46-0.64). Reliability improved following the introduction of mRS training (K = 0.56, 95% CI: 0.44-0.67; vs K = 0.69, 95% CI: 0.62-0.77). Validity ranged from poor to excellent, with an excellent overall concurrent validity of novel scales (n = 6 studies, KW = 0.86, 95% CI: 0.75-0.97). The agreement between face-to-face and telephone administration was substantial (n = 5 studies, KW = 0.80, 95% CI: 0.74-0.87).

Discussion: 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.

Conclusion: Interventions to improve mRS reliability (training, structured interview, adjudication) seem to be beneficial, but single interventions do not completely remove reliability concerns.

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比较改良兰金量表的传统方法和新方法的特性：系统回顾和荟萃分析。

简介改良 Rankin 量表（mRS）是中风研究中最常用的功能测量方法，但受到评分者间可靠性（IRR）的限制。已有多种干预措施可改善 mRS 的应用。我们旨在比较不同的 mRS 评估方法的特性：我们检索了多学科数据库（MEDLINE、EMBASE、Health and Psychosocial Instruments [OVID]、CINAHL、PsycINFO [EBSCO]）中描述 mRS 心理测量特性的成人中风研究。两名研究人员独立筛选了 20% 的标题和摘要，审阅了所有完整的研究，提取了数据并进行了偏倚风险 (ROB) 分析。随机效应荟萃分析的主要结果是通过卡帕（K）和加权卡帕（KW）测量的IRR。此外，还对有效性和模式间可靠性测量（Spearman's rho、KW）进行了总结：从 897 个标题中，有 46 项研究符合条件，包括 12 种不同的 mRS 方法和 8608 名参与者。14项研究（30.4%）的ROB较高。总体而言，可靠性相当高（n = 29 项研究，K = 0.65，95% CI：0.58-0.71），但新的 mRS 方法，例如 Rankin 重点评估（n = 2 项研究，K = 0.94，95% CI：0.90-0.98）的 IRR 高于标准 mRS（n = 13 项研究，K = 0.55，95% CI：0.46-0.64）。引入 mRS 培训后，可靠性有所提高（K = 0.56，95% CI：0.44-0.67；vs K = 0.69，95% CI：0.62-0.77）。效度从差到优不等，新量表的总体并发效度极佳（n = 6 项研究，KW = 0.86，95% CI：0.75-0.97）。面对面施测与电话施测之间的一致性很好（n = 5 项研究，KW = 0.80，95% CI：0.74-0.87）：讨论：mRS 是一种有效的功能测量方法，但 IRR 仍是一个问题。讨论：mRS是一种有效的功能测量方法，但IRR仍是一个问题。目前的研究结果受限于高ROB和可能的发表偏倚：结论：提高 mRS 可靠性的干预措施（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可靠性问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.