The traditional dichotomization of mRS does not reflect the wide range of pre-stroke status, and incorporating "return to pre-stroke mRS score" as a favorable outcome metric alongside the conventional dichotomy provides a more individualized measure, improving treatment evaluation and supporting tailored care strategies, particularly for patients with higher pre-stroke mRS scores.
Of 3,724 admitted ischemic stroke patients, 2,070 met inclusion criteria, and most had a favorable pre-stroke mRS.
Among patients with favorable pre-stroke mRS, fewer than half achieved a favorable outcome, at both discharge and 90 days.
Return to baseline mRS at discharge did not differ significantly by pre-stroke mRS group.
At 90 days, return to baseline was more frequent in patients with favorable pre-stroke mRS than in those with unfavorable pre-stroke mRS.
Redefining favorable outcome to include return to pre-stroke mRS increased the proportion of patients with favorable outcome.
Pre-stroke mRS 3-5 was strongly associated with death by 90 days in multivariable analysis.
Pre-stroke mRS 3-5 was not associated with return to baseline in all patients, but among survivors it was associated with a higher probability of return to baseline.
The authors conclude that return to pre-stroke mRS should be used as an additional outcome metric alongside the conventional dichotomy.
Stroke recovery is often judged with the modified Rankin Scale, which rates disability from 0 (no symptoms) to 6 (death). A score of 0-2 is usually called a "good" outcome. But many older patients were already significantly disabled before their stroke (scores of 3-5), so they can never be counted as having a good outcome, even if they recover fully to their previous state. This study looked at 2,070 ischemic stroke patients at one center treated between 2010 and 2022. It compared the usual definition of a good outcome with a new one that also counts a return to the patient's pre-stroke score. Adding this measure raised the share of patients with a favorable outcome slightly, from 42.0% to 44.3% at discharge and from 41.9% to 43.3% at 90 days. Patients with prior disability had a much higher risk of dying within 90 days, but among those who survived, they were more likely to get back to their pre-stroke level than patients without prior disability. This research suggests that judging stroke outcomes only by the standard cutoff overlooks meaningful recovery in patients who were already disabled. Using "return to baseline" alongside the traditional measure could give a fairer picture of how well treatments work for these patients. The study was retrospective and done at a single center, so the findings need confirmation elsewhere.
Schulz J, Reich A, Weyland C, Ridwan H, Hasan D, May R, et al.. (2026). Rethinking favorable outcomes: "return to baseline" as an additional outcome in ischemic stroke.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1866829