Comparing Patient-Reported and Physician-Assessed Modified Rankin Scale Scores Among Adults With Chronic Neurologic Disorders in Zambia.

OBJECTIVES

The modified Rankin Scale (mRS) is commonly used to assess functional status, but validation in African populations is limited. We aimed to (1) evaluate concordance between clinician-assessed and patient-reported mRS among adults with chronic neurologic conditions in Zambia and (2) explore reasons for scoring discrepancies.

METHODS

A mixed-methods, cross-sectional study was conducted among adults with chronic neurologic disorders in Zambia. Neurologists completed an in-person mRS evaluation, and participants completed a patient-reported mRS questionnaire. Semistructured interviews explored reasoning for scoring discrepancies. Quadratic weighted kappa statistics measured concordance between clinician and patient scores. Interviews were inductively coded to identify sources of scoring disagreement.

RESULTS

Among 100 participants (mean age 53 ± 14 years; 55 women), overall weighted kappa was 0.63 (95% CI 0.4830-0.7549), indicating substantial agreement between clinician-assessed and patient-reported mRS, with exact score matches in 46% of cases. Interviews revealed several contributors to scoring discordance, including difficulty interpreting questionnaire items, cultural norms around household roles, reliance on caregiver assistance, emphasis on nonmotor symptoms such as pain/fatigue, and limitations to leisure or occupational activities.

DISCUSSION: The patient-reported mRS demonstrated substantial agreement with clinician evaluations in the outpatient setting. However, important dimensions of patient-experienced disability, particularly nonmotor, livelihood, and psychosocial impacts remain underrepresented in this scale.