Assess Recovery with Confidence: The Rankin Focused Assessment (RFA)
The Rankin Focused Assessment (RFA) is a structured method used to assign scores on the Modified Rankin Scale (mRS), which measures the degree of disability or dependence in daily activities of people who have suffered a stroke.
Key Features of the RFA:
- Purpose: To improve the reliability and consistency of mRS scoring by providing a systematic approach.
- Structure: The RFA consists of five sections, each corresponding to different levels of disability on the mRS.
- Scoring Range: The mRS ranges from 0 (no symptoms) to 6 (death).
- Assessment Sources:
- Patient interviews
- Family or caregiver input
- Clinical staff observations
- Chart notes and direct examination
- Focus: Emphasizes functional capacity rather than just observed behavior. For example, if a patient could perform a task but chooses not to, they are rated based on capability.
- Ambulation Emphasis: A variant called RFA-A (Ambulation) focuses specifically on walking ability
- Improved Reliability: Studies show that RFA significantly improves inter-rater agreement compared to unstructured methods (Kappa score of 0.95 vs. 0.46)
The Rankin Focused Assessment (RFA) is widely used in clinical trials, especially those involving stroke patients, due to its ability to improve the reliability and consistency of disability grading. Raters must show competency in the use of the RFA by first certifying on the Modified Rankin Scale (mRS) training and certification program. This tool is widely used in clinical trials and stroke rehabilitation settings to ensure consistent and objective disability grading.
Here are its key applications:
- Primary Outcome Measure in Stroke Trials
- The Modified Rankin Scale (mRS), which the RFA helps standardize, is the most common primary outcome measure in acute stroke trials
- It assesses global disability, assigning patients to one of seven levels from 0 (no symptoms) to 6 (death).
- Improved Interrater Reliability
- Clinical trials often involve multiple raters across different sites. The RFA provides clear, operationalized criteria, reducing subjective interpretation and enhancing interrater agreement.
- In the FAST-MAG trial, RFA achieved 94% agreement among raters and a weighted kappa of 0.99, indicating near-perfect reliability
- Efficiency and Practicality
- The RFA takes only 3–5 minutes to administer, making it practical for use in large multicenter trials
- It uses multiple sources of information (patient, caregiver, clinical staff, chart notes) to ensure a comprehensive assessment.
- FDA and Regulatory Preference
- The FDA prefers mRS ratings that consider all of a patient’s conditions, not just stroke-related deficits. The RFA supports this by focusing on functional capacity rather than just observed behavior
- Training and Standardization
- The RFA is often used in conjunction with training programs and certification protocols to ensure consistency across trial sites.
- It includes detailed instruction sheets and rating forms to guide assessors through the process