title: Initial experience of a digital training resource for modified Rankin scale assessment in clinical trials.
abstract: OBJECTIVE
  The modified Rankin Scale (mRS) is the preferred measure of disability in cerebrovascular clinical trials, but its value is restricted by interobserver variability. Poor reliability reduces the statistical power of clinical trials and leads to underestimation of effect size. Strategies to improve mRS grading are required. Video training has previously improved application of the National Institutes of Health Stroke Scale in clinical research. We developed an mRS training resource in an attempt to minimize interobserver variability.
  
  
  METHODS
  We produced a complete training resource comprising an instructional DVD with accompanying written materials and assessment recordings of patient interviews. Formal assessment of training involved grading of real-life cases. Results of initial training and recertification were collected centrally and scored.
  
  
  RESULTS
  Data from 1564 assessments are presented. The majority of assessors were participating in 2 large prospective clinical stroke trials. Assessors represented a mixed group of disciplines and nationalities. After training, most trainees (90%) achieved certification in mRS assessment. The majority (85%) of investigators who did not reach an acceptable score on initial testing achieved certification after further exposure to the package.
  
  
  CONCLUSIONS
  Mass training in mRS assessment for clinical trials is possible. We outline the development of a video-based training package, including technical issues, patient selection procedures, and methods of scoring and assessment. Certification results suggest that use of the resource can improve mRS grading. Acceptability of the training has been demonstrated by its successful use in 2 international acute stroke trials, SAINT 1 and CHANT.
authors.affiliation: Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. tjq1t@clinmed.gla.ac.uk
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Quinn
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.forename: Hans-Goran
authors.initials: HG
authors.lastname: Hardemark
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Walters
mesh_terms: D002568:Certification / Q000379:methods; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards; D003200:Computer User Training / Q000379:methods; D004185:Disability Evaluation; D006801:Humans; D020407:Internet; D009462:Neurology / Q000193:education*; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D018579:Patient Selection; D020521:Stroke / Q000628:therapy*; D013663:Teaching / Q000379:methods* / Q000706:statistics & numerical data; D014741:Video Recording