{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:34:09Z","timestamp":1760060049646,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NSERC Alliance","award":["ALLRP 580440"],"award-info":[{"award-number":["ALLRP 580440"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Informatics"],"abstract":"<jats:p>The modified Rankin Scale (mRS) is a widely used outcome measure for assessing disability in stroke care; however, its administration is often affected by subjectivity and variability, leading to poor inter-rater reliability and inconsistent scoring. Originally designed for hospital discharge evaluations, the mRS has evolved into an outcome tool for disability assessment and clinical decision-making. Inconsistencies persist due to a lack of standardization and cognitive biases during its use. This paper presents design principles for creating a standardized clinical assessment tool (CAT) for the mRS, grounded in human\u2013computer interaction (HCI) and cognitive engineering principles. Design principles were informed in part by an anonymous online survey conducted with clinicians across Canada to gain insights into current administration practices, opinions, and challenges of the mRS. The proposed design principles aim to reduce cognitive load, improve inter-rater reliability, and streamline the administration process of the mRS. By focusing on usability and standardization, the design principles seek to enhance scoring consistency and improve the overall reliability of clinical outcomes in stroke care and research. Developing a standardized CAT for the mRS represents a significant step toward improving the accuracy and consistency of stroke disability assessments. Future work will focus on real-world validation with healthcare stakeholders and exploring self-completed mRS assessments to further refine the tool.<\/jats:p>","DOI":"10.3390\/informatics12030078","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T10:13:51Z","timestamp":1754475231000},"page":"78","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Designing a Patient Outcome Clinical Assessment Tool for Modified Rankin Scale: \u201cYou Feel the Same Way Too\u201d"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7303-1759","authenticated-orcid":false,"given":"Laura","family":"London","sequence":"first","affiliation":[{"name":"Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS B3J 1B6, Canada"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5957-2183","authenticated-orcid":false,"given":"Noreen","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS B3J 1B6, Canada"},{"name":"Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3J 1B6, Canada"},{"name":"Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS B3J 1B6, Canada"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1161\/01.STR.0000258355.23810.c6","article-title":"Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials: A literature review and synthesis","volume":"38","author":"Banks","year":"2007","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Po\u017carowszczyk, N., Kurkowska-Jastrz\u0119bska, I., Sarzy\u0144ska-D\u0142ugosz, I., Nowak, M., and Karli\u0144ski, M. (2023). Reliability of the modified Rankin Scale in clinical practice of stroke units and rehabilitation wards. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1064642"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1159\/000267278","article-title":"The Modified Rankin Scale in Acute Stroke Has Good Inter-Rater-Reliability but Questionable Validity","volume":"29","author":"Zhao","year":"2010","journal-title":"Cerebrovasc. Dis."},{"key":"ref_4","unstructured":"Zeltzer, L. (2008, April 19). Modified Rankin Scale (MRS). Stroke Engine. Available online: https:\/\/strokengine.ca\/en\/assessments\/modified-rankin-scale-mrs\/#Purpose."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1258\/RSMSMJ.53.1.44","article-title":"Dr John Rankin; His Life, Legacy and the 50th Anniversary of the Rankin Stroke Scale","volume":"53","author":"Quinn","year":"2008","journal-title":"Scott. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1177\/1747493020951941","article-title":"Look closer: The multidimensional patterns of post-stroke burden behind the modified Rankin Scale","volume":"16","author":"Rethnam","year":"2021","journal-title":"Int. J. Stroke Off. J. Int. Stroke Soc."},{"key":"ref_7","unstructured":"Cumming School of Medicine (2025, April 09). ESCAPE Stroke. University of Calgary. Available online: https:\/\/cumming.ucalgary.ca\/escape-stroke."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1056\/NEJMoa1414905","article-title":"Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke","volume":"372","author":"Goyal","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/S0140-6736(20)30258-0","article-title":"Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): A multicentre, double-blind, randomised controlled trial","volume":"395","author":"Hill","year":"2020","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1557234X13492978","article-title":"Diagnostic Reasoning and Decision Making in the Context of Health Information Technology","volume":"8","author":"Patel","year":"2013","journal-title":"Rev. Hum. Factors Ergon."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/JME.JME_59_24","article-title":"Navigating Sample Size Estimation for Qualitative Research","volume":"5","author":"Sharma","year":"2024","journal-title":"J. Med. Evid."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hennink, M., and Kaiser, B.N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc. Sci. Med., 292.","DOI":"10.1016\/j.socscimed.2021.114523"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"135","DOI":"10.7326\/0003-4819-120-2-199401150-00007","article-title":"Effects of computer-based clinical decision support systems on clinician performance and patient outcome: A critical appraisal of research","volume":"120","author":"Johnston","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Shortliffe, E.H., and Cimino, J.J. (2021). Human-Computer Interaction, Usability, and Workflow. Biomedical Informatics, Springer.","DOI":"10.1007\/978-3-030-58721-5"},{"key":"ref_15","unstructured":"Lidwell, W., Holden, K., and Butler, J. (2010). Universal Principles of Design: 125 Ways to Enhance Usability, Influence Perception, Increase Appeal, Make Better Design Decisions, and Teach Through Design (Revised and Updated), Rockport Publishers."},{"key":"ref_16","unstructured":"Johnson, J. (2014). Designing with the Mind in Mind: Simple Guide to Understanding User Interface Design Guidelines, Morgan Kaufmann."}],"container-title":["Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9709\/12\/3\/78\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:22:33Z","timestamp":1760034153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9709\/12\/3\/78"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["informatics12030078"],"URL":"https:\/\/doi.org\/10.3390\/informatics12030078","relation":{},"ISSN":["2227-9709"],"issn-type":[{"type":"electronic","value":"2227-9709"}],"subject":[],"published":{"date-parts":[[2025,8,4]]}}}