The modified Rankin Scale (mRS), the most widely used functional outcome measure in stroke, is an ordinal scale ranging from 0 (no symptoms) to 5 (severe disability) and 6 (death).1The e-smRSq 2 is based on the revised version of the simplified mRS questionnaire (smRSq)3 , 4 and aims to improve the reliability of mRS scoring.

Instructions for use

Ask the patient or proxy the questions below and follow the instructions to get the mRS score. Hover the cursor over or click the questions for hints. Click the 'Reset' button to begin again.

Answer this question by selecting 'Yes' or 'No' from the options below.

Can the patient live alone without any help from another person? This includes bathing, using the toilet, preparing or getting meals, shopping and managing finances.

Hint:For patients not living alone, could they live alone if they had to? Could they be left alone at home for periods of a week or more without concern?

The Modified Rankin Scale Scoring Guide5

Score 0 - no symptoms

Patients have no residual symptoms after their stroke, not even minor symptoms.

Score 1 - no significant disability

Able to carry out all usual activities despite some symptoms.If patients have any symptoms resulting from the stroke, whether physical or mental, then they should be scored at least 1 on the Rankin scale. For example, if they have any new difficulty in speech, reading or writing, in physical movement, sensation, vision or swallowing, or any change in their mood that does not limit their activities, they still should score 1. Patients in this category can continue to take part in all of their previous work, social and leisure activities. For this purpose, “usual” is regarded as any activity that they used to undertake for a monthly basis or more frequently. An inability to drive only because of legal impediment where the participant is otherwise physically able would not warrant a score of 2.

Score 2 - slight disability.

Able to look after own affairs without assistance, but unable to carry out all previous activities. If there is any activity that they used to undertake that they can no longer do since the stroke, whether because of a physical limitation or because they have chosen to give up the activity as a result of the stroke, then they should be scored 2. For example, a patient would be scored in this category if he used to play golf and is no longer able to do so, or if he used to have a job whereas he now no longer works. The patient should still be able to look after himself without any daily help. In other words he will be able to dress, move around, eat, go to the toilet, prepare simple meals, undertake shopping and make short journeys by himself. He will not require any supervision from other people and could safely be left at home for periods of a week or more without any concern.

Score 3 - moderate disability

These patients require some external help for daily activities but are able to walk without assistance. They may use a stick or a frame for walking but the assistance of another person is not required for this. They will be able to manage daily activities such as dressing, toileting, feeding etc., but will need help for more complex tasks such as shopping, cooking or cleaning or will need to be visited more often than weekly for some other purpose. The external help may simply be advisory, for example supervision for their financial affairs.

Score 4 - moderately severe disability

Unable to attend to own body needs without assistance and unable to walk unassisted. These patients are not independently mobile and will need help with daily tasks such as dressing, toileting or eating. They will need to be visited at least daily or will need to live in close proximity to a carer. To discriminate patients in category 4 from those in 5, consider whether the patient can regularly be left along for moderate periods of a few hours during the day.

Score 5 - severe disability

Requires constant nursing care and attention, bedridden, incontinent. Patients who cannot be left alone even for a few hours should be given the score of 5. Someone else will always need to be available during the day and at time during the night, although this will not necessarily be a trained nurse.

Score 6 - dead

General guidance:

In those with dysphasia or cognitive impairment, interview of both the patient and a proxy may be required. When in doubt between 2 categories, always stick to the key discriminators of the scale. If there is still some doubt between two alternatives on the scale and both options appear equally valid, then the worse option should be chosen.