Abstract 142: Automated Text-Messaging System for Assessment of 90-day Modified Rankin Scale After Stroke

Abstract

Background: The modified Rankin scale (mRS) is commonly used to measure disability after stroke, traditionally assessed through telephone or in-person evaluation. Here, we investigated the validity of mRS assessment through automated text-messaging as an alternative method to traditional assessments. Methods: Two hundred and fifty patients admitted to 3 hospitals within the University of Pennsylvania Health System with ischemic or hemorrhagic stroke were enrolled. Participants received automated text-messages 48 hours prior to their outpatient appointment at about 90-days post-stroke. The mRS scores were assigned based on participant responses to 2-4 yes/no questions, based on the simplified modified Rankin scale questionnaire (SmRSq). The mRS was then evaluated in-person or by telephone interview for comparison. Responses were compared with kappa(κ). Results: Among the one hundred and forty-two patients (57%) who completed the study: mean age 62 years; 45% female; 48% white, 45% black; 84% ischemic stroke; median baseline NIHSS 4. The patient was the responder in 63%, surrogate in 37%. Spontaneous response rate to text messages was 46% and up to 72% with an additional direct in-person or phone call reminder. Agreement (Figure) was substantial (quadratic-weighted κ=0.87) between responses derived from the automated text messaging and traditional interviews. Agreement for distinguishing functional independence (mRS 0-2) from dependence (mRS 3-5) was substantial (unweighted κ=0.79). Conclusion: An automated text messaging system is a feasible and highly reliable tool for determining mRS and can serve as an alternative to traditional in-person or telephone assessment.