Analyzing the modified rankin scale using concepts of the international classification of functioning, disability and health

BACKGROUND: The World Health Organization (WHO) suggests using the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for disability outcomes and the modified Rankin Scale (mRS) as an outcome measure in stroke. AIM: The aim of this study was to analyze the content of the mRS and the mRS-Systematic Interview (mRS-SI) by linking the scales to the ICF and to explore the association between the mRS and the ICF Core Set for stroke. DESIGN: Analysis of mRS and mRS-SI using ICF linking rules, as well as quantitative analysis using cross-sectional data. SETTING: In- and outpatient settings, community dwelling individuals after stroke. METHODS: Both scales were independently linked to the ICF and correlations between the mRS scores and the sum of problems in functioning, deriving from 266 stroke patients, were assessed under the components of the ICF Core Set for Stroke, the domains of 'Activities and Participation' and 15 second level categories linked to the mRS. RESULTS : Twelve meaningful concepts in the mRS and 40 meaningful concepts in the mRS-SI were identified and linked to different ICF categories, covering 9% and 32% of the ICF Core Set for stroke respectively. The strongest association of the mRS scores was with the number of problems in 'Activities and Participation', especially with the 'Self-care', 'Mobility' and 'Domestic life' domains, as well as with single categories of 'Moving around using equipment', 'Changing basic body position', 'Walking' and 'Carrying out daily routine'. CONCLUSIONS: The content of the mRS and the mRS-SI can be linked to the ICF framework. But the content may not be related to a specific outcome that would be in accordance with the disability terminology suggested by the World Health Organization. CLINICAL REHABILITATIO N IMPACT : In order to follow the ICF model, interpretation of mRS rating requires caution.