title: Validation of a structured interview for telephone assessment of the modified Rankin Scale in Brazilian stroke patients.
abstract: BACKGROUND
  The modified Rankin Scale (mRS) is a commonly used scale to assess the functional outcome after stroke. Several studies on mRS showed good reliability, feasibility, and interrater agreement of this scale using a face-to-face assessment. However, telephone assessment is a more time-efficient way to obtain an mRS grade than a face-to-face interview. The aim of this study was to validate the telephone assessment of mRS among the Portuguese using a structured interview in a sample of Brazilian stroke patients.
  
  
  METHODS
  We evaluated 50 stroke outpatients twice. The first interview was face-to-face and the second was made by telephone and the time between the two assessments ranged between 7 and 14 days. Four certified raters evaluated the patients using a structured interview based on a questionnaire previously published in the literature. Raters were blinded for the Rankin score given by the other rater. For both assessments, the rater could also interview a caregiver if necessary.
  
  
  RESULTS
  The patients' mean age was 62.8 ± 14.7, mean number of years of study 5.2 ± 3.4, 52% were males, 55.2% of patients needed a caregiver's help to answer the questions. The majority of caregivers were female (85%), mean age 49.1 ± 15, and mean number of years of study 8.3 ± 3.4. Perfect agreement between the telephone and face-to-face assessments was obtained for 27 (54%) patients, corresponding to an unweighted Kappa of 0.44 (95% CI 0.27-0.61) and a weighted Kappa of 0.89. The median of telephone assessment mRS was 3.5 (interquartile range = 2-4) and of face-to-face assessment was 4 (interquartile range = 2-5). There was no difference between the two assessments (Wilcoxon test, p = 0.35).
  
  
  CONCLUSIONS
  Despite the low education level of our sample, the telephone assessment of functional impairment of stroke patients using a translated and culturally adapted Brazilian Portuguese version of the mRS showed good validity and reliability. Therefore, the telephone assessment of mRS can be used in clinical practice and scientific studies in Brazil.
authors.affiliation: Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Jussara A O
authors.initials: JA
authors.lastname: Baggio
authors.forename: Taiza E G
authors.initials: TE
authors.lastname: Santos-Pontelli
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Cougo-Pinto
authors.forename: Millene
authors.initials: M
authors.lastname: Camilo
authors.forename: Nathalia F
authors.initials: NF
authors.lastname: Silva
authors.forename: Paula
authors.initials: P
authors.lastname: Antunes
authors.forename: Laura
authors.initials: L
authors.lastname: Machado
authors.forename: João P
authors.initials: JP
authors.lastname: Leite
authors.forename: Octavio M
authors.initials: OM
authors.lastname: Pontes-Neto
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology; D003466:Cultural Characteristics; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D011237:Predictive Value of Tests; D019114:Remote Consultation / Q000295:instrumentation*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013689:Telephone; D014175:Translating