Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity (original) (raw)
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Neurorehabilitation
The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw= 0.84). Intra-rater reliability was good for shoulder adductors (κw=0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the we...
Archives of Physical Medicine and Rehabilitation, 1999
Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watldns CL. Reliability of the Tone Assessment Scale and modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil 1999;80: 1013-6. Objectives: To establish reliability of the Tone Assessment Scale and modified Ashworth scale in acute stroke patients. Setting: A North Liverpool university hospital. Patients: Eighteen men and 14 women admitted with acute stroke and still in hospital at the study start date (median age, 74 yrs; median Barthel score, 8). Main Outcome Measures: The modified Ashworth scale and the Tone Assessment Scale.
Spinal Cord, 2009
Study design: Observational study. Objectives: To report the intra-rater (one rater), inter-rater (two raters) and inter-session (one subject, sessions 1-5) reliability of lower extremity modified Ashworth scale (MAS) scores among patients with chronic spinal cord injury (SCI). Setting: Tertiary Academic Rehab Centre in Toronto, Canada. Methods: MAS scores of 20 subjects with chronic SCI (C5-T10 AIS A-D412 months) were recorded for the hip abductors and adductors, knee flexors and extensors, and ankle plantar and dorsiflexors. MAS scores were assessed by two blinded raters (A and B) at the same time of day, weekly for 5 weeks using standardized test positions, a one-cycle per second metronome, with ratings recorded on the second cycle. MAS score reproducibility [intra-rater, inter-rater] were calculated using Cohen's Kappa. Intraclass correlation coefficients (ICCs) were calculated to determine inter-session (trials 1-5) reliability; Kappa values X0.81 and ICC values X0.75 were desired. Results: Intra-rater reliability was fair to almost perfect (0.2oko1.0) and differed between raters. Inter-rater reliability was poor-to-moderate (ko0.6) for all muscle groups. Inter-session reliability for a single rater was fair-to-good (0.4oICCo0.75) for all muscle groups. Conclusions: MAS was not reliable as an intra-rater tool for all raters, and showed poor inter-rater and modest inter-session reliability. MAS has inadequate reliability for determining lower extremity spasticity between raters (inter-rater) or over time (inter-session). It is recommended that the rehabilitation science community seek alternative measures for quantifying spasticity.
2011
The Modified Modified Ashworth Scale (MMAS) is a clinical instrument for measuring spasticity. Few studies have been performed on the reliability of the MMAS. The aim of the present study was to investigate the intrarater reliability of the MMAS for the assessment of spasticity in the lower limb. We conducted a test-retest study on spasticity in the hip adductors, knee extensors, and ankle plantar flexors. Each patient was measured by a hospital-based clinical physiotherapist. Twenty-three patients with stroke or multiple sclerosis (fourteen women, nine men) and a mean +/-standard deviation age of 37.3 +/-14.1 years participated. The weighted kappa was moderate for the hip adductors (weighted kappa = 0.45, standard error [SE] = 0.16, p = 0.007), good for the knee extensors (weighted kappa = 0.62, SE = 0.12, p < 0.001), and very good for the ankle plantar flexors (weighted kappa = 0.85, SE = 0.05, p < 0.001). The kappa value for overall agreement was very good (weighted kappa = 0.87, SE = 0.03, p < 0.001). The reliability for the ankle plantar flexors was significantly higher than that for the hip adductors. The intrarater reliability of the MMAS in patients with lower-limb muscle spasticity was very good, and it can be used as a measure of spasticity over time.
Physical therapy, 2002
Abnormal muscle tone is a common motor disorder following stroke, which may require rehabilitation. The Modified Ashworth Scale is a 6-point rating scale that is used to measure muscle tone. The interrater and intrarater reliability of measurements obtained with the scale remain equivocal. The purpose of this study was to investigate the reliability of measurements obtained with the scale in the lower limb of patients with stroke. Twenty patients were tested 2 weeks after their stroke, and 12 patients were tested 12 weeks after their stroke. Gastrocnemius, soleus, and quadriceps femoris muscles on the hemiplegic side were tested. Interrater reliability for 2 raters was poor, with a Kendall tau-b correlation for the combined muscle group of.062 (P=.461). For intrarater reliability, the Kendall tau-b correlation was.567 (P<.001). The agreement within one rater occurred mostly on the grade of 0. The Modified Ashworth Scale yielded reliable measurements in the lower limb for a single...
…, 2009
The Modified Modified Ashworth Scale (MMAS) is a simple clinical outcome measure to assess muscle spasticity in people with brain injury. The objective of this cross-sectional study was to assess the interrater reliability of the MMAS in the upper limb of adult patients with hemiplegia. Participants were fifteen patients with a mean age of 57.3 ± 14.4 years. They had brain injury on average 33.3 ± 26.2 months earlier. Two common spastic muscle groups (elbow flexor and wrist flexor) on the hemiparetic side of the patients were rated by two physiotherapists according to a standardized protocol. The order of raters' assessment and the sequence of muscle testing was randomized. The weighted Kappa (κw) values were calculated for reliability. The κw was 0.61 for elbow flexor and 0.78 for wrist flexor. Results support the good interrater reliability of the MMAS for persons with upper limb spasticity.
The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke
Journal of NeuroEngineering and Rehabilitation, 2008
Background: Spasticity is a common impairment that follows stroke, and it results typically in functional loss. For this reason, accurate quantification of spasticity has both diagnostic and therapeutic significance. The most widely used clinical assessment of spasticity is the modified Ashworth scale (MAS), an ordinal scale, but its validity, reliability and sensitivity have often been challenged. The present study addresses this deficit by examining whether quantitative measures of neural and muscular components of spasticity are valid, and whether they are strongly correlated with the MAS. Methods: We applied abrupt small amplitude joint stretches and Pseudorandom Binary Sequence (PRBS) perturbations to both paretic and non-paretic elbow and ankle joints of stroke survivors. Using advanced system identification techniques, we quantified the dynamic stiffness of these joints, and separated its muscular (intrinsic) and reflex components. The correlations between these quantitative measures and the MAS were investigated. Results: We showed that our system identification technique is valid in characterizing the intrinsic and reflex stiffness and predicting the overall net torque. Conversely, our results reveal that there is no significant correlation between muscular and reflex torque/stiffness and the MAS magnitude. We also demonstrate that the slope and intercept of reflex and intrinsic stiffnesses plotted against the joint angle are not correlated with the MAS. Conclusion: Lack of significant correlation between our quantitative measures of stroke effects on spastic joints and the clinical assessment of muscle tone, as reflected in the MAS suggests that the MAS does not provide reliable information about the origins of the torque change associated with spasticity, or about its contributing components.
Objectives: The purpose of this study was to investigate Iintra-rater reliability of the Modified Tardieu Scale (MTS) in elbow flexors and ankle plantar flexors in adult subjects with stroke. Materials and Methods: A total of 91 subjects with stroke participated in this test-retest study. Intra-rater reliability of the MTS was investigated by a qualified and trained physiotherapist for elbow flexors and ankle plantar flexors in two sessions. A rater was one who performed the procedure and an observer only records the angles so that the rater was blinded to findings. Outcome measures in this study were measurable components of MTS, which are angle of muscle reaction (R1), passive range of motion (R2), dynamic component (R2-R1), and quality of muscle reaction (grade 0 – 4) termed as MTS score. Results: Intra-rater reliability of MTS was very good for R1, R2, R2-R1, and MTS score (ICC > 0.85, P<0.0001) across two sessions in elbow flexors and ankle plantar flexors. Conclusion: MTS is a reliable clinical tool for measurement of spasticity in the elbow flexors and ankle plantar flexors in adult subjects with stroke.
Stop using the Ashworth Scale for the assessment of spasticity
Journal of Neurology, Neurosurgery & Psychiatry, 2010
Aim. Many studies have been performed upon the methodological qualities of the (modified) Ashworth Scale, but overall these studies seem insufficiently conclusive. Aim of this study is to investigate the construct validity and inter-rater reliability of the Ashworth Scale (AS) for the assessment of spasticity in upper and lower extremities. Method. A cross-sectional study on spasticity in the elbow flexors (part 1) and knee extensors (part 2) was carried out. In both parts AS was assessed, while muscle activity and resistance was recorded simultaneously, in patients with upper motor neuron syndrome. Each patient was measured by three raters.