the medical research council scale

MedicalCRITERIA.com

Unifying concepts, medical research council (mrc) scale for muscle strength.

The muscle scale grades muscle power on a scale of 0 to 5 in relation to the maximum expected for that muscle.

• Grade 5: Muscle contracts normally against full resistance.
• Grade 4: Muscle strength is reduced but muscle contraction can still move joint against resistance.
• Grade 3: Muscle strength is further reduced such that the joint can be moved only against gravity with the examiner’s resistance completely removed. As an example, the elbow can be moved from full extension to full flexion starting with the arm hanging down at the side.
• Grade 2: Muscle can move only if the resistance of gravity is removed. As an example, the elbow can be fully flexed only if the arm is maintained in a horizontal plane.
• Grade 1: Only a trace or flicker of movement is seen or felt in the muscle or fasciculations are observed in the muscle.
• Grade 0: No movement is observed.
• Grade 0: normal.
• Grade 1: no disability; minor sensory signs or areflexia.
• Grade 2: mild disability; ambulatory for >200 m; mild weakness in one or more limbs and sensory impairment.
• Grade 3: moderate disability; ambulatory for >50 m without stick; moderate weakness MRC Grade 4 and sensory impairment.
• Grade 4: severe disability; able to walk >10 m with support of stick; motor weakness MRC Grade 4 and sensory impairment.
• Grade 5: requires support to walk 5 m; marked motor and sensory signs.
• Grade 6: cannot walk 5 m, able to stand unsupported and able to transfer to wheelchair, able to feed independently.
• Grade 7: bedridden, severe quadriparesis; maximum strength MRC grade 3.
• Grade 8: respirator and/or severe quadriparesis; maximum strength MRC grade 2.
• Grade 9: respirator and quadriplegia.
• Grade 10: dead.

Modified Medical Research Council (mMRC) Dyspnea Scale

References:

• Medical Research Council. Aids to the examination of the peripheral nervous system, Memorandum no. 45, Her Majesty’s Stationery Office, London, 1981.
• Hahn AF, Bolton CF, Pillay N, et al. Plasma exchange therapy in chronic inflammatory demyelinating polyneuropathy. A double-blind, sham controlled, cross-over study. Brain 1996;119:1055–66. [Medline]
• Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, Bittner C, Fialka-Moser V. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med. 2008 Aug;40(8):665-71. [Medline]

Created: Mar 23, 2009.

Related Posts

The numeric rating scale (NRS) is a single 11-point numeric scale broadly validated across myriad patient…

The Hachinski ischemic score (HIS) is known to be a simple clinical tool, currently used…

Instructions: This scale is intended to record your own assessment of any sleep difficulty you…

Preoperative anxiety is a frequent and challenging problem with deleterious effects on the development of…

The Karnofsky Performance Status Scale (KPS) was designed to measure the level of patient activity…

Users Online

Medical disclaimer, recent posts.

• Diagnostic Criteria for Cannabis Use Disorder
• Psoriasis Area Severity Index (PASI) Score
• Diagnostic Criteria for Catatonia
• Diagnostic Criteria for Dengue Hemorrhagic Fever (DHS) and Dengue Shock Syndrome (DSS)
• Diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES)
• About Us (1)
• Allergy (3)
• Anesthesiology (5)
• Cardiology (54)
• Critical Care (17)
• Dermatology (7)
• Diabetes (14)
• Endocrinology and Metabolism (20)
• Epidemiology (6)
• Family Practice (7)
• Gastroenterology (63)
• Hematology (40)
• Immumology (6)
• Infectious Disease (44)
• Internal Medicine (1)
• Nephrology (17)
• Neurology (79)
• Nutrition (29)
• Obstetrics & Gynecology (20)
• Oncology (13)
• Ophthalmology (4)
• Orthopedic (5)
• Otolaryngology (5)
• Pathologic (1)
• Pediatrics (14)
• Pharmacology (3)
• Physical Therapists (7)
• Psychiatry (51)
• Pulmonary (23)
• Radiology (5)
• Rheumatology (52)
• Surgery (8)
• Urology (5)

Popular of the Last Month

• Diagnostic Criteria for Anorexia Nervosa (DSM-V) 671 views
• DSM-5 Diagnostic Criteria for Schizophrenia 586 views
• Diagnostic Criteria for Bulimia Nervosa (DSM-5) 506 views
• DSM-5 Diagnostic Criteria for Panic Disorder 412 views
• Stage Classification of Gastric Ulcer by Sakita-Miwa 265 views
• GLIM Criteria for the Diagnosis of Malnutrition 265 views
• DSM-5 Diagnostic Criteria for Dyspraxia/Developmental Coordination Disorder 252 views
• Edmonton Obesity Staging System (EOSS) 241 views
• DSM-5 Diagnostic Criteria for Major Depressive Disorder 234 views
• DSM-5 Diagnostic Criteria for Autism Spectrum Disorder (ASD) 209 views

Copyright by MedicalCriteria.com

Last Updated on 27 July, 2021 by Guillermo Firman

• Open access
• Published: 18 September 2020

Medical Research Council-sumscore: a tool for evaluating muscle weakness in patients with post-intensive care syndrome

• Zeynep Turan   ORCID: orcid.org/0000-0001-8142-3467 1 ,
• Mahir Topaloglu 1 &
• Ozden Ozyemisci Taskiran 1  

Critical Care volume  24 , Article number:  562 ( 2020 ) Cite this article

22k Accesses

27 Citations

16 Altmetric

Metrics details

Dear Editor,

COVID-19 may lead to severe acute respiratory distress syndrome requiring intensive care unit (ICU) support. Patients surviving respiratory distress could develop post-intensive care syndrome (PICS) that includes ICU-acquired weakness (ICUAW). Nearly 66% of COVID-19 patients have clinically important muscle weakness following discharge [ 1 ]. Therefore, communication between the critical care and rehabilitation physician is important to evaluate the physical function of COVID-19 survivors to start rehabilitation timely.

The comprehensive examination of muscle strength in COVID-19 is not easy. Muscle strength can be evaluated by manual muscle testing and dynamometer. Electrophysiological study is important in diagnosing critical illness neuromyopathy; however, its correlation with muscle weakness is not clear. Ultrasonography can detect atrophy and structural changes but does not correlate with muscle function [ 2 ].

Medical Research Council (MRC)-sumscore evaluates global muscle strength. Manual strength of six muscle groups (shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion) is evaluated on both sides using MRC scale. Summation of scores gives MRC-sumscore, ranging from 0 to 60. This score was developed for detecting early strength alterations in patients with Guillain-Barré syndrome, especially who were bedridden and receiving artificial ventilation. The sensitivity and interobserver agreement of MRC-sumscore was demonstrated [ 3 ]. Despite its ceiling effect, this score reliably identifies significant weakness (< 48) and even better in severe weakness (< 36) [ 4 ] which is the main medical interest for treatment in ICUAW.

Handgrip strength is a rapid, simple, and objective tool that is measured by handheld dynamometer represents global muscle strength. The cutoff value for handgrip strength in critically ill patients is defined as < 11 kg force for males and < 7 kg force for females which is below that of the age- and sex-matched patients [ 5 ]. It was proposed as an alternative to MRC in ICUAW [ 5 ]. However, examination of other muscles by MRC-sumscore might give additional information since the neurological consequences of COVID-19 are not clear yet. ICUAW is more pronounced in proximal muscles; therefore, direct evaluation of proximal muscles is also valuable. MRC is associated with mortality, hospital, and ICU-free days in ICUAW more strongly than handgrip strength [ 5 ].

In conclusion, MRC-sumscore is a valid, reliable, objective, and easy method to evaluate the global muscle strength including PICS related to COVID-19. It provides beneficial information about the clinical course. Its bedside applicability without necessitating any device makes MRC-sumscore a valuable tool in the follow-up of patients with PICS.

Availability of data and materials

Not applicable

Abbreviations

Intensive care unit

Intensive care unit acquired weakness

Medical Research Council

Post-intensive care syndrome

Wang Z, Wang Z, Sun R, Wang X, Gu S, Zhang X, et al. Timely rehabilitation for critical patients with COVID-19: another issue should not be ignored. Version 2. Crit Care. 2020;24(1):273. https://doi.org/10.1186/s13054-020-02967-7 .

Article   PubMed Central   PubMed   Google Scholar  

Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care. 2015;19(1):274. https://doi.org/10.1186/s13054-015-0993-7 .

Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve. 1991;14(11):1103–9. https://doi.org/10.1002/mus.880141111 .

Article   CAS   PubMed   Google Scholar  

Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012;45(1):18–25. https://doi.org/10.1002/mus.22219 .

Article   PubMed   Google Scholar  

Ali NA, O’Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178(3):261–8. https://doi.org/10.1164/rccm.200712-1829OC .

Download references

Acknowledgements

No competing interest exist.

Author information

Authors and affiliations.

Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Maltepe Mah, Davutpasa Cad, No:4, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey

Zeynep Turan, Mahir Topaloglu & Ozden Ozyemisci Taskiran

You can also search for this author in PubMed   Google Scholar

Contributions

ZT contributed substantially to the conception and design of the study, drafted and provided critical revision of the article, and took responsibility in necessary literature review for the study. MT contributed substantially to the conception of the study and took responsibility in necessary literature review for the study. OOT contributed substantially to the conception and design of the study and drafted and provided critical revision of the article. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zeynep Turan .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests, additional information, publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Turan, Z., Topaloglu, M. & Ozyemisci Taskiran, O. Medical Research Council-sumscore: a tool for evaluating muscle weakness in patients with post-intensive care syndrome. Crit Care 24 , 562 (2020). https://doi.org/10.1186/s13054-020-03282-x

Download citation

Received : 13 July 2020

Accepted : 11 September 2020

Published : 18 September 2020

DOI : https://doi.org/10.1186/s13054-020-03282-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Critical Care

ISSN: 1364-8535

• Submission enquiries: [email protected]

134k followers

13k followers

290k followers

824k followers

MRC Scale | Muscle Strength Grading | Strength Testing

• Assessment E-Book

MRC stands for Medical Research Council which is the institution that sets up the standard for muscle strength testing.

The strength can be categorized on a level from zero to five. In our example, we will use the extension of the knee joint. So, the muscle which we are going to test is the Quadriceps.

The levels are as follows:

• Grade 0: The patient cannot activate the muscle, so no movement is observed. For grade 0, ask the patient to contract his quadriceps. He can do this by pushing the back of his knee into the bench. For grade 0, I will not see or feel a flicker or trace of contraction or movement.
• Grade 1: the patient can activate the muscle, without moving the limb. So only a trace or flicker of movement is seen or felt during palpation of the muscle. For grade 1, ask the patient to do the exact same thing, and this time, you will see or feel a muscle flicker or trace of movement.
• Grade 2: movement over the full range of motion can only occur if gravity is eliminated. In order to distinguish between grades 1 and 2, we have to bring our patient in side-lying position to eliminate gravity. Then, I will support the leg of my patient, bring it into full flexion and ask my patient to move into extension. If my patient is able to move through the full range of motion, this is a grade 2. If no movement is possible at all, we are talking about grade 1.
• Grade 3: the patient can overcome gravity and move through the full range of motion without resistance coming from the examiner. For grade 3, I’ll ask my patient to extend his knee against gravity.
• Grade 4: weakness with resistance. So your patient can move through the full range of motion with moderate resistance coming from the examiner. For grade 4, I will give moderate resistance against the extension of my patient’s knee.
• Grade 5: full strength. So your patient can move through the whole range of motion against full resistance coming from the examiner.And for grade 5, give full resistance against the extension of the patient’s knee. In order to distinguish between a grade 4 and 5, make sure to compare both legs.

Now that you’ve seen the basics of how to test according to the MRC scale, make sure to practice this with different joints and muscles and figure out a way of how to position your patient.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

BUY THE FULL PHYSIOTUTORS ASSESSMENT BOOK

• 600+ Pages e-Book
• Interactive Content (Direct Video Demonstration, PubMed articles)
• Statistical Values for all Special Tests from the latest research
• Clinical Value Recommendation
• Detailed descriptions & searchable
• Currently on Version 6.0 – Free lifetime updates
• Available in 🇬🇧 🇩🇪 🇫🇷 🇪🇸 🇮🇹 🇵🇹 🇹🇷
• And much more!

ALL ORTHOPEDIC TESTS IN ONE PLACE

What customers have to say about the Assessment E-Book

Create your free account to gain access to this exclusive content and more!

To provide the best experiences, we and our partners use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us and our partners to process personal data such as browsing behavior or unique IDs on this site and show (non-) personalized ads. Not consenting or withdrawing consent, may adversely affect certain features and functions.

Click below to consent to the above or make granular choices. Your choices will be applied to this site only. You can change your settings at any time, including withdrawing your consent, by using the toggles on the Cookie Policy, or by clicking on the manage consent button at the bottom of the screen.

Download our free physiotherapy app with all the knowledge you need.

MRC Dyspnoea Scale - MRC

The MRC Dyspnoea Scale, also called the MRC Breathlessness Scale, has been in use for many years for grading the effect of breathlessness on daily activities. This scale measures perceived respiratory disability, using the World Health Organization (WHO) definition of disability being “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being”.

The MRC Dyspnoea Scale is simple to administer as it allows the patients to indicate the extent to which their breathlessness affects their mobility.

The 1-5 stage scale is used alongside the questionnaire to establish clinical grades of breathlessness.

MRC Breathlessness Scales: 1952 and 1959

Questionnaire on Respiratory Symptoms

The questionnaire was first published in 1960 under the approval of the MRC Committee on the Aetiology of Chronic Bronchitis. This was revised and a new version published in 1966. When the committee disbanded, the responsibility for it was passed to the newly formed MRC Committee for Research into Chronic Bronchitis who again revised it in 1976. When this committee disbanded, the responsibility for the questionnaire passed to the Committee on Environmental and Occupational Health (CEOH) who reviewed it and issued what remains to be the most recent version in 1986.

The Questionnaire on Respiratory Symptoms was designed to be used in large scale epidemiological studies only (100-1,000 people). It cannot be used on an individual basis.

Questionnaire on respiratory symptoms and instructions to interviewers (1966)

Questionnaire on respiratory symptoms and instructions to interviewers (1976)

Questionnaire on respiratory symptoms and instructions to interviewers (1986)

Permission to reuse the MRC Dyspnoea Scale

In accordance with MRC’s Open Access Policy , permission is granted from the MRC to use the MRC Dyspnoea Scale for any purpose (including research and commercial purposes) and MRC hereby agrees not to assert its rights in relation to the proposed use of the MRC Dyspnoea Scale.

You must give appropriate credit (“Used with the permission of the Medical Research Council”) and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests that the MRC endorses you or your use.

We cannot give permission to use any modified versions of this scale including the MRC Scale.

Note: The MRC is not in a position to authorise translations or check back-translations

Contact information

Ask a question, or get further information about any of the MRC scales. Email: [email protected]

For information about licensing

To view the full Open Government Licence, visit National Archives: Open Government Licence Version 2 .

Further context, best practice and guidance can be found in the National Archives: UK Government Licensing Framework .

LifeArc manages MRC’s intellectual property rights and commercialises findings by licensing them to industry. They can be contacted for support via the contact information on their website .

Last updated: 24 January 2022

This is the website for UKRI: our seven research councils, Research England and Innovate UK. Let us know if you have feedback or would like to help improve our online products and services .

Validation of the Generalized Anxiety Disorder-7 (GAD-7) in Russian people with epilepsy

Affiliations.

• 1 Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation. Electronic address: [email protected].
• 2 Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
• 3 Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation.
• 4 Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation.
• 5 Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation.
• PMID: 34500434
• DOI: 10.1016/j.yebeh.2021.108269

Objective: To assess the capacity of Generalized Anxiety Disorder-7 (GAD-7) to detect anxiety disorders in a Russian sample of patients with epilepsy and to validate this instrument for rapid screening of anxiety in these patients.

Methods: Study included 233 patients with epilepsy, both inpatients and outpatients. For all patients Mini-International Neuropsychiatric Interview was conducted as a gold standard for diagnosis of mental disorders. All patients also completed the questionnaires - the Russian version of GAD-7 and Hospital Anxiety and Depression Scale (HADS) to assess convergent validity. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Mann-Whitney test was used for the quantitative ones. Internal consistency was assessed using Cronbach's alpha, Cronbach's alpha at point deletion, and corrected point-to-point correlation. ROC analysis was used to evaluate the properties of the GAD-7 to determine anxiety disorders.

Results: Among 97 (41.6%) patients with epilepsy diagnosed with any anxiety disorders, 42 (18%) had panic disorder, 37 (15.9%) had agoraphobia, 17 (7.3%) had social anxiety disorder, and 64 (27.5%) had generalized anxiety disorder; 42 patients (18%) showed a combination of several anxiety disorders. The overall GAD-7 score was similar to other epilepsy studies, but higher cutoff scores characterize our sample. The scale performed well in detecting any anxiety disorder with the AUC of 0.866 and the optimal cutoff point > 8 points, and in detecting GAD with AUC = 0.922 and the optimal cutoff point > 9 points, showing overall acceptable sensitivity.

Conclusion: Russian version of the GAD-7 could be used as a screening tool for any anxiety disorders in PWE with the optimal cutoff score > 8 points.

Keywords: Anxiety; Epilepsy; GAD-7; Generalized anxiety disorder; Mini-International Neuropsychiatric Interview.

Copyright © 2021 Elsevier Inc. All rights reserved.

• Anxiety Disorders / diagnosis
• Anxiety Disorders / epidemiology
• Epilepsy* / diagnosis
• Epilepsy* / epidemiology
• Patient Health Questionnaire*
• Psychiatric Status Rating Scales
• Psychometrics
• Reproducibility of Results
• Russia / epidemiology
• Sensitivity and Specificity