Abstract Details

Title Improving the Reliability of Rankin Scale Stroke Disability Grading in Clinical Trials and Clinical Practice: The Rankin Focused Assessment - Ambulation (RFA - A)

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S32 - (-)

Poster/Presentation
Number 003

Objective

Background The modified Rankin (mRS) global disability scale is the most widely employed primary outcome measure in acute stroke trials and has been recently added as a routine clinical practice outcome assessment in the US national Get With the Guidelines - Stroke registry. However, unstructured mRS assessments have been shown to have poor inter-rater reliability.

Design/Methods The RFA-A is a modification of the validated Rankin Focused Assessment developed to meet user requests for an instrument that emphasized ambulation (as did the original Rankin Scale) rather than mobility (via walking or wheelchair, a common approach in rehabilitation assessment of disability). The RFA-A takes 3-5 minutes to apply and provides clear, operationalized criteria to distinguish the 7 assignable global disability levels. The RFA-A was prospectively validated 3 months post-stroke among 50 consecutive patients enrolled in the phase 3 NIH FAST-MAG Trial.

Results Among the 50 patients, mean age 71.5 (range 43-93), 48% were female, and stroke subtype was hemorrhagic in 24%. At day 90, 43 patients were alive and 7 had died. The mRS median was 2.0 and mean 2.8. When pairs of 14 raters assessed all enrolled patients, the percent agreement was 94%, the weighted kappa was 0.99 (95% CI 0.99-1.0), and the unweighted kappa was 0.93 (95% CI 0.85-1.00). Among the 43 surviving patients, the percent agreement was 93%, the weighted kappa was 0.99 (0.98-1.0), and the unweighted kappa was 0.91 (0.82-1.00).

Conclusions The Rankin Focused Assessment - Ambulation yields high inter-rater reliability in the grading of final global disability among consecutive stroke patients. The RFA-A is brief and practical for use in multicenter clinical trials and quality improvement activities.

Authors/Disclosures
Richa Patel PRESENTER	No disclosure on file
Sidney Starkman, MD, FAAN (UCLA Emergency Medicine Center)	No disclosure on file
Roland John	No disclosure on file
Scott Hamilton	No disclosure on file
	No disclosure on file
	No disclosure on file
Robin A. Conwit, MD, FAAN	Dr. Conwit has nothing to disclose.
Jeffrey L. Saver, MD, FAAN (UCLA Health)	Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer Ingelheim (prevention only). Dr. Saver has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. Dr. Saver has received stock or an ownership interest from Rapid Medical.

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