Response to Letter by Quinn et al
We are grateful for the interest of Dr Quinn et al1 in our work and are pleased that none of the criticisms advanced in their letter apply to the Rankin focused assessment (RFA) that was the subject of our report.
The RFA does not seek to reduce the time spent in deriving a Rankin score. By requiring formal assessment of several domains of function, the RFA actually precludes overly rapid, snap judgments that can occur with holistic assessments.
The RFA is not inflexibly reductionist, although it is operationalized. For many patients, use of the RFA forces a multi-domain assessment that structurally counteracts overly reductionist tendencies that can occur in less ordered encounters.
The design of the RFA recognizes that patients may occasionally struggle to answer a categorical question regarding their capacities and activities. In such instances, the RFA takes the approach recommended by Quinn et al,1 explicitly directing raters to obtain information from all available sources, including other informants and the medical record, to arrive at a final assessment regarding each line item.
We concur with Quinn et al1 that additional studies comparing the RFA against traditional and alternative Rankin assessment techniques would be most welcome. We also agree that additional benefits may be gained by combining a focused assessment with central adjudicator panel scoring, but we emphasize the importance of making available to the central review committee not only the video of an interview with a single patient informant but also all other available salient data, including physician, nursing, and rehabilitation therapist assessments in the medical record, the concurrent neurological examination, and interviews with family and caretakers.