Connecting Upper Limb Functional Stroke Recovery to Global Disability Measures: Finding the Forest in the Trees

The modified Rankin Scale (mRS) is the most widely used outcome measure in stroke trials. It is a hierarchical scale, defining categorical outcomes that are assigned numerical values that range from no symptoms (mRS score 0) to death (mRS score 6).1,2 It is commonly dichotomized into independent recovery (mRS score 0–2) vs death or dependence (mRS score 3–6). The origin of the scale lies not in rigorous clinimetric development but in the pragmatic desire to compare outcomes from different approaches to stroke treatment.3 Its longevity relates partly to chance, being available as an outcome measure in the first generation of acute stroke trials in the 1990s, partly to its brevity and lack of need for specialized training or tools, and partly to its role as a broad measure of global activities limitations (also known as disability) applicable to strokes of all anatomic locations and types. Its near-universal use as an outcome measure in acute stroke trials has led to a high degree of familiarity and acceptance across the spectrum of stroke research, including clinicians, researchers, and regulators.

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