title: The Rankin Focused Assessment-Ambulation: A Method to Score the Modified Rankin Scale with Emphasis on Walking Ability.
abstract: BACKGROUND
  In the assessment of poststroke functional outcome, there are 2 alternative approaches to rating patient independence in motion: (1) focusing solely on patient ambulation (discounting self-use of wheelchair) and (2) focusing broadly on patient mobility (counting self-use of wheelchair). This study was undertaken to create and assess the inter-rater reliability of a version of the Rankin Focused Assessment (RFA) that focuses on ambulation (Rankin Focused Assessment-Ambulation [RFA-A]), as an alternative to the original RFA that focused on mobility (Rankin Focused Assessment-Mobility [RFA-M]).
  
  
  METHODS
  The RFA-A was created by changing instructions in the RFA-M for handling of nonambulatory, wheelchair-using patients. Paired study coordinators then applied the RFA-A to 50 consecutive patients enrolled in a phase 3 acute stroke trial.
  
  
  RESULTS
  Among the 50 patients, the mean age was 72 years (range 43-93) and 48% were female. Overall, study coordinator pairs assigned the same modified Rankin Scale (mRS) grades to 48 of the 50 patients, yielding a weighted κ of .98 (95% confidence interval [CI] .96-1.00) and an unweighted κ of .95 (95% CI .89-1.02). At day 90, 43 patients were alive and 7 had died. Among surviving patients, the weighted κ was .98 (95% CI .95-1.00) and the unweighted κ was .94 (95% CI .86-1.02). The κ values for all 6 dichotomizations of the mRS score ranged from .93 to 1.00.
  
  
  CONCLUSIONS
  The RFA-A demonstrates high inter-rater reliability in grading global functional outcome. The RFA-A is a useful tool for assigning an mRS score in research and clinical practice when functional assessment focused on ambulation is desired.
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California; Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Richa D
authors.initials: RD
authors.lastname: Patel
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California.
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.affiliation: Stanford Stroke Center, Department of Neurology, Stanford University, Palo Alto, California.
authors.forename: Scott
authors.initials: S
authors.lastname: Hamilton
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California.
authors.forename: Sharon
authors.initials: S
authors.lastname: Craig
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California.
authors.forename: Anna
authors.initials: A
authors.lastname: Grace
authors.affiliation: National Institute for Neurological Disorders and Stroke, Bethesda, Maryland.
authors.forename: Robin
authors.initials: R
authors.lastname: Conwit
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California. Electronic address: jsaver@ucla.edu.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D016138:Walking / Q000502:physiology*
keywords: Rankin; Scales; ambulation; assessment; disability