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Properties of proxy-derived modified Rankin Scale assessment
Kate McArthur1, Michael L C Beagan, Andrew Degnan
1Institute of Cardiovascular and Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UK.
Summary
Proxy assessment of the modified Rankin Scale (mRS) shows potential for variability. Direct patient interviews for mRS are preferred due to questionable validity in some proxy assessments.
Area of Science:
- Neurology
- Clinical Assessment
- Rehabilitation
Background:
- Cognitive or communication impairments can prevent direct modified Rankin Scale (mRS) interviews.
- Surrogate interviews are often necessary but their clinimetric properties are not well-established.
Purpose of the Study:
- To evaluate the reliability of proxy-derived mRS assessments.
- To compare proxy mRS with direct patient interview data.
Main Methods:
- Stroke inpatients and their proxies underwent non-structured mRS assessments.
- Paired, blinded interviewers conducted independent patient and proxy mRS evaluations.
- Interobserver variability and agreement were analyzed using kappa statistics and percentage agreement.
Main Results:
- Ninety-seven stroke survivors were assessed with proxies including family (n=29), nurses (n=50), and physiotherapists (n=25).
- Patient mRS reliability was kappa=0.70; proxy mRS reliability was kappa=0.62.
- Agreement between patient and proxy mRS was kappa=0.64, with variations across proxy types.
Conclusions:
- Proxy modified Rankin Scale (mRS) assessments can exhibit significant interobserver variability.
- The validity of certain proxy mRS evaluations is uncertain, underscoring the preference for direct patient interviews.
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