Modified Rankin Scale (mRS)
Global disability and dependence after stroke
- Rankin 1957, Scotland
- Modified: van Swieten 1988, Rotterdam
Sources last checked: 2026-10-13
Modified Rankin Scale (mRS)
Global disability and dependence after stroke
A single global rating with only moderate unweighted inter-rater agreement; a structured interview improves reliability. Grade 6 (death) is a trial convention, not part of the 1988 publication.
Interpretation
| 0–1 — no significant disability | Often reported as 'excellent outcome' (mRS 0–1) in stroke trials. |
|---|---|
| 2 — slight disability, independent | mRS 0–2 is the usual definition of functional independence. |
| 3–5 — dependent | Needs help from others, from some assistance (3) to constant care (5). |
| 6 — dead | Grade 6 was added for trial outcome analysis; the 1988 scale has grades 0–5. |
What is the Modified Rankin Scale (mRS)?
The modified Rankin Scale grades global disability after stroke on seven levels, from 0 (no symptoms) to 6 (death). Rankin described the original five-grade scale in Glasgow in 1957; van Swieten and colleagues in Rotterdam published the modified 0–5 version with an inter-observer study in 1988, and grade 6 was later added for trial analyses. It is the dominant primary outcome in stroke trials and in European stroke registries.
When to use it
- Functional outcome at 90 days after stroke, the standard time point in trials and registries.
- Documenting pre-stroke function, which influences reperfusion and rehabilitation decisions.
- Discharge planning and communication with rehabilitation teams.
- Outcome reporting after intracerebral or subarachnoid haemorrhage.
When not to use it
- For acute severity grading — use the NIHSS in the hyperacute phase.
- When detailed self-care assessment is needed for care planning; activity-of-daily-living instruments give more resolution.
- As a sole measure of cognitive or mood outcomes, which it captures poorly.
How it is calculated
| Criterion | Points |
|---|---|
| Current level of function | |
| 0 — No symptoms | 0 |
| 1 — Symptoms, but no significant disability; all usual activities | 1 |
| 2 — Slight disability; cannot do all previous activities, looks after own affairs | 2 |
| 3 — Moderate disability; needs some help, walks unassisted | 3 |
| 4 — Moderately severe; cannot walk or attend to bodily needs unassisted | 4 |
| 5 — Severe; bedridden, incontinent, constant nursing care | 5 |
| 6 — Dead | 6 |
Clinical pearls and limitations
- A single global rating with only moderate unweighted inter-rater agreement; a structured interview improves reliability. Grade 6 (death) is a trial convention, not part of the 1988 publication.
- The decisive question between grades 3 and 4 is walking without help of another person; between 2 and 3 it is needing any help from others.
- A structured interview (e.g. the mRS-9Q or Rankin Focused Assessment) reduces inter-rater disagreement.
- Grade 1 means symptoms without any limitation of usual activities, not 'mild stroke'.
- Pre-morbid disability matters: a patient with pre-stroke mRS 3 cannot be expected to reach mRS 0–2.
Frequently asked questions
What counts as a good outcome on the mRS?
Trials usually call mRS 0–1 an excellent outcome and mRS 0–2 functional independence. Many trials now analyse the whole scale (shift analysis) rather than a single cut-off.
Can the mRS be assessed by telephone?
Yes. Structured telephone interviews show reasonable agreement with face-to-face assessment and are widely used for 90-day follow-up.
Why does the mRS go to 6?
Grade 6 (death) was added so that trial analyses include all randomised patients; the 1988 publication describes grades 0–5.
Evidence and guidelines
- Primary source: van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19(5):604-607.
- Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2(5):200-215.
- Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials. Stroke 2007;38(3):1091-1096.
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