Why standardize the Rankin scale since it is 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:
An automated flowchart for the Modified Rankin Scale assessment: A multicenter inter-rater agreement analysis
Abstract
Background and objective:
The
Modified Rankin Scale (mRS) is a widely adopted scale for assessing
stroke recovery. Despite limitations, the mRS has been adopted as
primary outcome in most recent clinical acute stroke trials. Designed to
be used by multidisciplinary clinical staff, the congruency of this
scale is not consistent, which may lead to mistakes in clinical or
research application. We aimed to develop and validate an interactive
and automated digital tool for assessing the mRS—the iRankin.
Methods:
A
panel of five board-certified and mRS-trained vascular neurologists
developed an automated flowchart based on current mRS literature. Two
international experts were consulted on content and provided feedback on
the prototype platform. The platform contained five vignettes and five
real video cases, representing mRS grades 0–5. For validation, we
invited neurological staff from six comprehensive stroke centers to
complete an online assessment. Participants were randomized into two
equal groups usual practice versus iRankin. The participants were
randomly allocated in pairs for the congruency analysis. Weighted kappa
(kw) and proportions were used to describe agreement.
Results:
A
total of 59 professionals completed the assessment. The kw was
dramatically improved among nurses, 0.76 (95% confidence interval
(CI) = 0.55–0.97) × 0.30 (0.07–0.67), and among vascular neurologists,
0.87 (0.72–1) × 0.82 (0.66–0.98). In the accuracy analysis, after the
standard mRS values for the vignettes and videos were determined by a
panel of experts, and considering each correct answer as equivalent to 1
point on a scale of 0–15, it revealed a higher mean of 10.6 (±2.2) in
the iRankin group and 8.2 (±2.3) points in the control group (p = 0.02).
In an adjusted analysis, the iRankin adoption was independently
associated with the score of congruencies between reported and standard
scores (beta coefficient = 2.22, 95% CI = 0.64–3.81, p = 0.007).
Conclusion:
The
iRankin adoption led to a substantial or near-perfect agreement in all
analyzed professional categories. More trials are needed to generalize
our findings. Our user-friendly and free platform is available at https://www.irankinscale.com/.
Get full access to this article
View all access and purchase options for this article.
No comments:
Post a Comment