Evidence map›Paper›PMID 35277444›Full record

ArticleNeurology2022

Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke.

Kimberly S Erler, Rui Wu, Julie A DiCarlo, Marina F Petrilli, Perman Gochyyev, Leigh R Hochberg, Steven A Kautz, Lee H Schwamm, Steven C Cramer, Seth P Finklestein and 1 more

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In one paragraph

Article in Neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Kimberly S ErlerFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Rui WuFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Julie A DiCarloFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Marina F PetrilliFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Perman GochyyevFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Leigh R HochbergFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Steven A KautzFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Lee H SchwammFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Steven C CramerFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
Seth P FinklesteinFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.
David J LinFrom the Center for Neurotechnology and Neurorecovery (K.S.E., R.W., J.A.D., L.R.H., D.J.L.), Division of Neurocritical Care (L.R.H, D.J.L.), Stroke Service (L.R.H., L.H.S., S.P.F., D.J.L.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Occupational Therapy (K.S.E.), Massachusetts General Hospital, Boston; School of Health and Rehabilitation Sciences (K.S.E., M.F.P., P.G., D.J.L.), MGH Institute of Health Professions, Boston, MA; VA RR&D Center for Neurorestoration and Neurotechnology (L.R.H., D.J.L.), VA Medical Center, Providence, RI; School of Health Sciences and Research (S.A.K.), Medical University of South Carolina, Charleston; Ralph H. Johnson VA Medical Center (S.A.K.), Charleston, SC; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles.

Funding

Treating Depression and Enhancing Locomotor Recovery Post-strokeP20GM109040 · NIGMS · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI KAUTZ, STEVEN A. · 2014 to 2024
$23.5M
Small Molecule Treatments to Enhance Neurological Recovery After StrokeR44NS095381 · NINDS · STEMETIX, INC. · PI FINKLESTEIN, SETH P · 2018 to 2018
$1.4M
RR&D Research Career Scientist Award ApplicationIK6RX003075 · VA · RALPH H JOHNSON VA MEDICAL CENTER · PI KAUTZ, STEVEN A. · 2020 to 2025
–
NIGMS NIH HHS P20 GM109040NINDS NIH HHS R44 NS095381RRD VA IK6 RX003075
6 · The paper itself

Abstract

BACKGROUND AND

objectivesPrecise measurement of outcomes is essential for stroke trials and clinical care. Prior research has highlighted conceptual differences between global outcome measures such as the modified Rankin Scale (mRS) and domain-specific measures (e.g., motor, sensory, language or cognitive function). This study related motor phenotypes to the mRS, specifically aiming to determine whether mRS levels distinguish motor impairment and function phenotypes, and to compare mRS outcomes to meaningful changes in impairment and function from acute to subacute recovery after stroke.

methodsPatients with upper extremity weakness after ischemic stroke were assessed with a battery of impairment and functional measures within the first week and at 90 days after stroke. Impairment and functional outcomes were examined in relation to 90-day mRS scores. Clinically meaningful changes in motor impairment, activities of daily living, and mobility were examined in relation to 90-day mRS score.

resultsIn this cohort of 73 patients with stroke, impairment and functional outcomes were associated with 90-day mRS scores but showed substantial variability within individual mRS levels: within mRS level 2, upper extremity impairment ranged from near hemiplegia (with an upper extremity Fugl-Meyer score 8) to no deficits (upper extremity Fugl-Meyer score 66). Overall, there were few differences in impairment and functional outcomes between adjacent mRS levels. While some outcome measures were significantly different between mRS levels 3 and 4 (Nine-Hole Peg, Leg Motor, gait velocity, Timed Up and Go, NIH Stroke Scale, and Barthel Index), none of the outcome measures differed between mRS levels 1 and 2. Fugl-Meyer and grip strength were not different between any adjacent mRS levels. A substantial number of patients experienced clinically meaningful changes in impairment and function in the first 90 days after stroke but did not achieve good mRS outcome (mRS score ≤ 2). DISCUSSION: The mRS broadly relates to domain-specific outcomes after stroke, confirming its established value in stroke trials, but it does not precisely distinguish differences in impairment and function, nor does it sufficiently capture meaningful clinical changes across impairment, activities of daily living status, and mobility. These findings underscore the potential utility of incorporating detailed phenotypic measures along with the mRS in future stroke trials.

Indexed as

StrokeStroke RehabilitationActivities of Daily LivingHumansPhenotypeRecovery of FunctionUpper Extremity

Identifiers

PMID35277444
PMCPMC9109148

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.