Modified Rankin Scale (mRS)

A 7-point global disability scale measuring functional independence after stroke.

Clinician-assigned, ideally from a structured interview; 5 to 15 minutes.
A single grade. 0 (no symptoms) to 5 (severe disability), with 6 recording death.
Favourable outcome typically defined as mRS 0 to 2.
Free to use. No formal training required, though a structured interview raises agreement.

Psychometrics

Inter-rater agreement, conventional gradingkappa 0.56

Inter-rater agreement, structured interviewkappa 0.74

Unweighted kappa between raters. Conventional grading is from van Swieten et al. (1988), 100 stroke patients rated in pairs by 34 neurologists and residents. Structured interview is from Wilson et al. (2005), 113 patients and 15 raters. Higher is better.

What does the mRS measure?

The mRS reduces global disability and dependence to a single grade. It asks how much help a person needs with their usual activities, whether they can walk, and whether they can attend to their own bodily needs. It does not break function into separate domains the way an activities of daily living scale does, which is what makes it quick and what makes the wording of the question matter so much.

That is why structured formats exist. Wilson and colleagues defined a set of questions covering constant care, basic and instrumental daily activities, participation in usual social roles, and a checklist of common stroke symptoms. The Rankin Focused Assessment and the nine-question mRS-9Q are shorter versions of the same idea. Each raises agreement between raters over free grading.

What does an mRS grade mean?

The grades below are the definitions published by van Swieten and colleagues in 1988.

Grade definitions for the modified Rankin Scale
Grade	Definition
0	No symptoms
1	No significant disability despite symptoms. Able to carry out all usual duties and activities.
2	Slight disability. Unable to carry out all previous activities, but able to look after own affairs without assistance.
3	Moderate disability. Requires some help, but able to walk without assistance.
4	Moderately severe disability. Unable to walk without assistance, and unable to attend to own bodily needs without assistance.
5	Severe disability. Bedridden, incontinent, and requiring constant nursing care and attention.
6	Death.

The 1988 scale ran from 0 to 5. Grade 6, recording death, was added later as the mRS became the standard endpoint in stroke trials, which is why some reference sources still describe six grades and others seven.

Trials most often report a grade of 0 to 2 as a favourable outcome, the range in which a person remains independent in daily life. Repeated over months and years, the grade tracks the course of recovery. It is reference information for the care team.

How the mRS is administered

Administered by: A clinician or trained interviewer. The mRS-9Q can be completed by non-medical study personnel.
Time to administer: 5 to 15 minutes. The Rankin Focused Assessment takes 3 to 5 minutes.
Equipment: Paper and pencil. No specialised equipment.
Cost: Free to take here.
Training required: None formally. A structured interview raises agreement between raters and is the usual practice in trials.
Remote administration: The mRS-9Q returns the same grade by telephone as on paper (weighted kappa 0.95)
Age range: Adults
Available languages: German, Persian, and Dutch translations are documented

Which conditions is the mRS used for?

Stroke

Related instruments

mRS questions, answered

What does each mRS grade mean?

0 is no symptoms. 1 is symptoms without significant disability, with all usual activities intact. 2 is slight disability, no longer able to do everything as before but independent in daily affairs. 3 is moderate disability, needing some help but walking without assistance. 4 is moderately severe disability, unable to walk or attend to bodily needs without assistance. 5 is severe disability, bedridden and needing constant care. 6 records death. The grade is reference information for the care team.

What is the mRS-9Q?

A set of nine yes-or-no questions that determines the mRS grade in a simple, reliable way, without needing a trained interviewer to grade freely. The assessment here follows this structured question format.

What counts as a good outcome on the mRS?

Stroke trials most often define a good outcome as a grade of 0 to 2, the range where a person remains independent in daily life.

Who assigns the grade?

A clinician. Agreement between raters is moderate when the grade is assigned freely and substantially better when it comes from a structured interview.

How long does the mRS take?

5 to 15 minutes. The Rankin Focused Assessment, a short structured version written for trials, takes 3 to 5 minutes and reached a weighted kappa of 0.99 between observers in its validation study.

Evidence, psychometrics and provenance

Rankin published the original scale in 1957 for patients over 60 who had had a cerebrovascular accident. Van Swieten and colleagues modified it in 1988, adding a grade for no symptoms and reporting the first agreement analysis. The structured formats that most trials now use came later, from Wilson and colleagues in 2005, Saver and colleagues in 2010, and Patel and colleagues in 2012.

Inter-rater agreement across many raters: kappa 0.25 for conventional grading across 15 raters and 113 patients (Wilson et al., 2005)
Intra-rater reliability: kappa 0.81 on repeat assessment (Wilson et al., 2005)
Test-retest reliability: kappa 0.81 to 0.95 across the literature (Banks and Marotta, 2007)
Rankin Focused Assessment: Weighted kappa 0.99 across 50 patients at 90 days (Saver et al., 2010)
mRS-9Q: kappa 0.80 against a structured interview (Patel et al., 2012)

References

This assessment uses a validated instrument and is reference information, not a diagnosis.