Mapping the mRS Scores Into the EQ-5D-5L in Patients With Ischemic Stroke

 

mRS and the Berthel Index ARE NOT DAMAGE DIAGNOSES, they do not give you the 3d location of your dead and damaged neurons. In my opinion, they are FUCKING WORTHLESS to getting you recovered! 

I consider the Rankin scale  useless, not objective except for #6, dead? You can't use it to objectively point to the EXACT STROKE PROTOCOLS  needed.  The exact same deficit could have 9 causes.

See this example of nine reasons for a movement disability:

 

You can't tell me these all have the same solution, I'm not that stupid.
1. Penumbra damage to the motor cortex.
2. Dead brain in the motor cortex.
3. Penumbra damage in the pre-motor cortex.
4. Dead brain in the pre-motor cortex.
5. Penumbra damage in the executive control area.
6. Dead brain in the executive control area.
7. Penumbra damage in the white matter underlying any of these three.
8. Dead brain in the white matter underlying any of these three.
9. Spasticity preventing movement from occurring.

The latest here: 

Mapping the mRS Scores Into the EQ-5D-5L in Patients With Ischemic Stroke

Florentina M.E. Pinckaers, MD, PhD https://orcid.org/0000-0002-8336-6897 floor.pinckaers@mumc.nl, Janneke P.C. Grutters, PhD https://orcid.org/0000-0002-2579-1561, Silvia M.A.A. Evers, PhD https://orcid.org/0000-0003-1026-570X, Hester F. Lingsma, MD, PhD https://orcid.org/0000-0003-2063-9533, Hieronymus D. Boogaarts, MD, PhD https://orcid.org/0000-0001-5855-2447, Diederik W.J. Dippel, MD, PhD https://orcid.org/0000-0002-9234-3515, Alida A. Postma, MD, PhD https://orcid.org/0000-0002-1116-054X, … Show All … , and Andrea Gabrio, PhD https://orcid.org/0000-0002-7650-4534Author Info & Affiliations

New online

https://doi.org/10.1161/STROKEAHA.126.055741

 

Abstract

BACKGROUND:

Mapping concerns the cross-walking of one health-related quality of life instrument to another. This study aimed to translate the modified Rankin Scale (mRS) score at 3 months after ischemic stroke into a 5-level version of the EQ-5D–based utility values, which may be used for the derivation of quality-adjusted life years for cost-effectiveness analyses.

METHODS:

Data from 3 Dutch multicenter phase III clinical trials in ischemic stroke were pooled (MR CLEAN-NO-IV, MR CLEAN-MED, and MR CLEAN-LATE). The mRS score and 5-level version of the EQ-5D were assessed by telephone interview at 3 months poststroke. The correlation (Spearman coefficient) between the mRS score and each 5-level version of the EQ-5D domain was assessed. Various direct and indirect mapping algorithms were explored. Model performance (predictive ability) was assessed using bootstrapping in the full testing set (mRS score 0–5) and in patients with independent (0–2) and dependent (3–5) mRS scores separately. Results were validated in an external validation set derived from a cross-sectional Dutch study. Final utility estimates per mRS score were assessed in the pooled trial and external validation data set.

RESULTS:

The 5-level version of the EQ-5D dimensions self-care, daily activities, and mobility demonstrated the strongest correlation to the mRS score (ρ=0.46–0.70). Correlation coefficients of the pain and anxiety dimensions were relatively poor (ρ=0.37–0.45). Indirect mapping with a multinomial logit model was identified as the preferred mapping algorithm. In the pooled data set, the median (interquartile range) age was 71 (62–79), and 56% of patients were male. Mean (SD) fitted utility values per mRS score were mRS score 0: 0.947 (0.004); mRS score 1: 0.860 (0.009); mRS score 2: 0.758 (0.013); mRS score 3: 0.597 (0.017); mRS score 4: 0.352 (0.017); and mRS score 5: 0.147 (0.017).

CONCLUSIONS:

The mean utility weights provided in this study may be used for the direct estimation of quality-adjusted life years from mRS scores. Furthermore, the multinomial logit model may be used to derive utility values from new data sets with different country-specific utility tariffs. Our results are ideally suited for application in cost-effectiveness analyses.

Graphical Abstract

The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke intervention trials. However, decisions on reimbursement are typically based on economic evaluations that rely on the use of quality-adjusted life years as a summary measure of health outcomes.1,2 Unfortunately, many studies do not include utility measures such as the EQ-5D3 within their research protocols, which are, in principle, a mandatory source for the computation of individual quality-adjusted life year values.4 To address this problem, several studies have created a value set for use in further analyses by mapping the mRS scores into utility values.4–8 These value sets have also been used in the creation of a utility-weighted mRS, which has been proposed and applied as an alternative primary outcome measure to the mRS.5,9

Previous studies concerning the mapping of the mRS scores into the EQ-5D have all used the 3-level version of the EQ-5D (EQ-5D-3L).4–8 However, the EQ-5D-3L is known to suffer from ceiling effects and overestimation of self-reported health issues.10 The newer 5-level version of the EQ-5D (EQ-5D-5L) has been shown to be superior to the EQ-5D-3L with respect to various measurement properties, including sensitivity and precision in health status measurement.11 As a result, several countries now recommend the usage of the EQ-5D-5L over the EQ-5D-3L.12

The mapping of mRS scores into an EQ-5D-5L value set has not yet been reported. This study aims to develop an algorithm for the estimation of EQ-5D-5L–derived utility values from mRS scores at 3 months poststroke using pooled data from 3 Dutch ischemic stroke intervention trials.