I cannot die happy until doctors stop using the 29 year old Modified Rankin Scale to evaluate the effectiveness of treatment (1). Research findings are highly suspect when researchers use a scale that is so general it captures only broad, sweeping changes after treatment (2). Not giving credit for dozens of functional gains between Level 5 (bedridden and needing constant nursing care) and Level 3 (requiring some help but able to walk without assistance) ignores significant gains that affect the quality of life of stroke survivors. I do not know if doctors keep using the outdated Rankin because they have not kept up with current research or they do not want to use a more sensitive outcome measure that requires training to administer and score.
0 No symptoms
1 No significant disability despite symptoms; able to carry out all usual duties and activities
2 Slight disability; unable to carry out all previous activities but able to look after own affairs
3 Moderate disability; requiring some help but able to walk without assistance
4 Moderately severe disability; unable to walk without assistance and unable to attend to own
bodily needs without assistance
5 Severe disability; bedridden, incontinent and requiring constant nursing care and attention
1. Bonita R, Beaglehole R. Modification of the Rankin Scale: Recovery of motor function after
stroke. Stroke. 1988; 19(12):1497-1500.
2. Kuntz A, Ebinger M, Geisler F. et al. Functional outcomes of pre-hospital thrombolysis in a
mobile stroke treatment unit compared with conventional care. Lancet. 2016;15(10):1035-1043.