# Utility-weighted modified rankin scale scores in patients with ischemic stroke: a multicenter observational study

## TL;DR

This study estimates quality of life in stroke patients using a modified ranking scale and patient-reported outcomes.

## Contribution

The study introduces utility-weighted modified Rankin Scale (UW-mRS) scores derived from real-world stroke patient data.

## Key findings

- Higher modified Rankin Scale (mRS) scores correlate with lower quality of life (QOL) in stroke patients.
- UW-mRS scores show a significant decline in quality of life between mRS scores 3 and 4.
- UW-mRS estimates vary based on assessment timing and country-specific utility values.

## Abstract

This study assessed patient-reported health-related quality of life (QOL) in a real-world cohort of patients with ischemic stroke and estimated utility-weighted modified Rankin Scale (UW-mRS) scores.

We included 1452 patients with ischemic stroke (median age: 75 [67–83] years; 41.0% female) from a multicenter hospital-based stroke registry in Japan. QOL was evaluated using the EQ-5D-5L with Japanese-specific utility values. Both EQ-5D utility values and mRS scores were assessed after completion of acute treatment. UW-mRS scores were estimated using ordinary least squares (OLS) and Tobit regression models.

The mean (SD) EQ-5D utility value was 0.68 (0.27). Higher mRS scores were associated with greater severity and frequency of problems across EQ-5D domains, with a marked decline observed between mRS scores 3 and 4. UW-mRS scores estimated by OLS were: mRS 0: 0.90, mRS 1: 0.85, mRS 2: 0.74, mRS 3: 0.62, mRS 4: 0.41, and mRS 5: 0.28. The Tobit model yielded slightly higher values for mRS 1–3. UW-mRS estimates remained largely consistent across other regression models (fractional logit/probit, beta regression, and two-part models). However, UW-mRS values differed between early (≤ 14 days from onset) and late (> 14 days) assessments and varied considerably when utility values were calculated using tariffs from other countries or with the EQ-5D-3L crosswalk.

In this real-world, consecutive cohort of hospitalized Japanese patients with ischemic stroke, utility values were estimated using the EQ-5D-5L, and the UW-mRS was characterized as a practical tool for deriving utility values from mRS scores.

The online version contains supplementary material available at 10.1007/s11136-025-04114-7.

Stroke can have a profound impact on individual’s lives, limiting physical abilities and adversely affecting overall well-being. In this study, we asked hospitalized patients with ischemic stroke in routine clinical practice to report their health status using the EQ-5D-5L, a questionnaire that measures health-related quality of life (HRQoL) across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. We estimated utility values for these patients and mapped scores on the modified Rankin Scale (mRS), a widely used measure of post-stroke functional status, to EQ-5D utility values. Our findings demonstrate a strong inverse relationship between functional disability and HRQoL, with the steepest decline observed between moderate and severe disability (mRS scores 3 to 4). The utility-weighted mRS (UW-mRS) scores derived from this real-world cohort may provide a practical approach for estimating patient-reported HRQoL from mRS scores commonly used in stroke research. However, UW-mRS values varied depending on the time from stroke onset to assessment, the value sets applied from different countries, and whether EQ-5D-5L results were mapped to the 3L. Therefore, caution is warranted when applying the UW-mRS for mapping across different settings or populations.

The online version contains supplementary material available at 10.1007/s11136-025-04114-7.