The SMILE-Stroke score, a novel patient-centered outcome measure, was feasible, reproducible, and associated with established functional and discharge outcomes in MT-treated patients with pre-stroke disability, and may complement the mRS by identifying preserved or regained patient-centered functional domains within poor mRS categories.
The SMILE-Stroke score demonstrated excellent interrater reliability for both the total score and dichotomized outcome.
Twelve of 31 patients (38.7%) with pre-stroke moderate-to-severe disability achieved a favorable SMILE-Stroke outcome after mechanical thrombectomy.
The SMILE-Stroke score correlated strongly with the discharge Barthel Index, supporting its convergent validity.
The SMILE-Stroke score showed a statistically significant graded association with discharge disposition.
The SMILE-Stroke score had good discriminative ability for distinguishing more versus less favorable discharge destinations.
A substantial proportion of patients classified as having poor outcomes by the mRS achieved favorable SMILE-Stroke outcomes, demonstrating that the mRS may miss meaningful functional recovery in disabled patients.
The SMILE-Stroke score comprises five patient-centered functional domains assessed on a 10-point scale.
Pre-stroke SMILE-Stroke scores were evaluated as part of the study, providing a baseline functional reference for the patient population.
This research suggests that a new scoring tool called SMILE-Stroke can better capture meaningful recovery after emergency stroke treatment (mechanical thrombectomy) in older adults who already had significant disability before their stroke. The standard scale used to measure stroke outcomes—the modified Rankin Scale (mRS)—classifies many of these patients as having 'poor' outcomes, but it may miss important improvements in daily functions like speaking, moving, eating, using the toilet, and engaging with others. The SMILE-Stroke score was designed to assess exactly these five areas, giving a fuller picture of what matters to patients in their everyday lives. In a study of 31 patients who had moderate-to-severe disability before their stroke and received mechanical thrombectomy, 38.7% achieved a favorable SMILE-Stroke score at discharge. The tool proved highly reliable when used by different raters, correlated strongly with another established functional measure (the Barthel Index), and was good at predicting where patients would go after leaving the hospital. Strikingly, nearly one-third of patients who were classified as having poor outcomes by the traditional mRS scale actually achieved a favorable SMILE-Stroke score, meaning they had regained meaningful function that the mRS alone did not detect. This research suggests that using the SMILE-Stroke score alongside the mRS could help clinicians, patients, and families better understand the real-world benefits of stroke treatment for people who were already living with disability. It may also help guide decisions about who might benefit from aggressive stroke interventions, a question that is currently difficult to answer using standard outcome measures alone. Larger studies will be needed to confirm these findings and further validate the tool.
Inoue H, Oomura M, Nakamura Y, Nishikawa Y, Uchida Y, Kusui S, et al.. (2026). Beyond the Rankin Scale: A Patient-Centered Score for Meaningful Recovery After Mechanical Thrombectomy in Older Adults With Pre-Stroke Disability.. Geriatrics & gerontology international. https://doi.org/10.1111/ggi.70874