1/🧵
#Newpub #Hotofthepress : A concrete application of our recent paper stressing the importance of assessing reliability of trial outcomes: validation of the simplified mRS for treated brain aneurysm pts!
lnkd.in/guqziccC
#Tweetorial #RadRes #NeuroTwitter #RadTwitter
#Newpub #Hotofthepress : A concrete application of our recent paper stressing the importance of assessing reliability of trial outcomes: validation of the simplified mRS for treated brain aneurysm pts!
lnkd.in/guqziccC
#Tweetorial #RadRes #NeuroTwitter #RadTwitter
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What previous paper, you say? In case you missed it, please check out why evaluating reliability for RCT outcome measures is as important as for diagnostic tests, if not more:
lnkd.in/g4piwx6T
What previous paper, you say? In case you missed it, please check out why evaluating reliability for RCT outcome measures is as important as for diagnostic tests, if not more:
lnkd.in/g4piwx6T
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As everyone knows, mRS is widely used for evaluating functional outcome in stroke pts.
A simplified version (smRS) was proposed by Bruno et al. for easier adjudication.
While reliability was extensively studied for stroke pts, it wasn't for patients with treated aneurysms.
As everyone knows, mRS is widely used for evaluating functional outcome in stroke pts.
A simplified version (smRS) was proposed by Bruno et al. for easier adjudication.
While reliability was extensively studied for stroke pts, it wasn't for patients with treated aneurysms.
4/
Moreover, mRS assessment in RCTs is usually only performed by certified stroke neurologists, which can be costly and of limited availability.
Expanding mRS evaluation to non-trained/certified staff could allow for a wider & more effective use & center recruitment.
Moreover, mRS assessment in RCTs is usually only performed by certified stroke neurologists, which can be costly and of limited availability.
Expanding mRS evaluation to non-trained/certified staff could allow for a wider & more effective use & center recruitment.
5/
We first did a sys review of all Kappa studies of RS showing:
- 7 modif. to initial RS
- Almost all studies were for disab. after stroke
- Higher K ➡️ Ranking Foc. Assessment (RFA) : 0.99
- Lower K ➡️ standard mRS: 0.25
- NO paper assessing mRS reliability after aneurysm Tx
We first did a sys review of all Kappa studies of RS showing:
- 7 modif. to initial RS
- Almost all studies were for disab. after stroke
- Higher K ➡️ Ranking Foc. Assessment (RFA) : 0.99
- Lower K ➡️ standard mRS: 0.25
- NO paper assessing mRS reliability after aneurysm Tx
6/
Inter-rater reliability of smRS was then evaluated between:
1. Vascular Neurosurgeon 🔪🩸
2. Certified Stroke Neurologist 🧠
3. Novice Research Assistant 🙋♀️
For 60 patients with clipped📎 or coiled🧶 intracranial aneurysms🎈 from two ongoing RCTs (CURES & ISAT-2).
Inter-rater reliability of smRS was then evaluated between:
1. Vascular Neurosurgeon 🔪🩸
2. Certified Stroke Neurologist 🧠
3. Novice Research Assistant 🙋♀️
For 60 patients with clipped📎 or coiled🧶 intracranial aneurysms🎈 from two ongoing RCTs (CURES & ISAT-2).
7/
Almost perfect inter-rater agreement (K>0.8) was reached for all pairs of raters, as well as overall.
Intra-rater was also >0.8.
High level of reliability was maintained when good outcome was defined as smRS=0-2 (K=0.87), but NOT when defined as smRS=0-1 (K=0.59).
Almost perfect inter-rater agreement (K>0.8) was reached for all pairs of raters, as well as overall.
Intra-rater was also >0.8.
High level of reliability was maintained when good outcome was defined as smRS=0-2 (K=0.87), but NOT when defined as smRS=0-1 (K=0.59).
8/
Moreover:
Significant difference (P=0.003) in smRS adjudication of good outcome between raters was found when smRS 0-1, while not the case when smRS 0-2 (P=0.52).
Moreover:
Significant difference (P=0.003) in smRS adjudication of good outcome between raters was found when smRS 0-1, while not the case when smRS 0-2 (P=0.52).
9/
That's it! a few take-home points:
1. smRS is a RELIABLE tool for assessing disability in patients with treated brain aneurysms.
2. Defining good outcome as smRS 0-2 is both more reliable AND clinically relevant.
3. Non-trained staff can RELIABLY perform smRS assessments.
That's it! a few take-home points:
1. smRS is a RELIABLE tool for assessing disability in patients with treated brain aneurysms.
2. Defining good outcome as smRS 0-2 is both more reliable AND clinically relevant.
3. Non-trained staff can RELIABLY perform smRS assessments.
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