Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity

Abstract

The measurement of spasticity is part of the neurological examination of patients with disorders of the central nervous system. Recently, the Modified Modified Ashworth Scale (MMAS) was developed for the characterization of muscle spasticity. The purpose of this study was to determine the interrater reliability of the MMAS in the assessment of wrist flexor muscle spasticity in adult patients after upper motoneuron lesions resulted in hemiplegia. Thirty hemiplegic patients (17 males and 13 females) with a mean age of 55.6+/-7.8 years participated in this study. The wrist flexor spasticity was assessed according to MMAS by two female physiotherapists. The raters gave 23 patients the same spasticity score (weighted percentage agreement=97.4%). The most agreement occurred for scores 3 (46.7%) and 0 (16.7%), respectively. The agreement between raters was very good (weighted kappa=0.92, SE=0.03, p<0.0001). In conclusion, the MMAS has very good interrater reliability for the assessment of wrist flexor muscle spasticity.

Measurement of lower-limb muscle spasticity: Intrarater reliability of Modified Modified Ashworth Scale

“…So far, the findings on the reliability of the MMAS have been good and very good [17][18][19][20][21]. In this study, moderate reliability was observed for the hip adductors and good reliability for knee extensors; however, these are lower than previous measures of intrarater reliability [17].…”

“…The relationship between the MMAS scores obtained from the wrist flexor muscle group and the H Slope /M Slope and H Max /M Max ratios was statistically significant (r = 0.39, p = 0.04) [22].…”

“…The kappa values were good between raters ( = 0.72, standard error [SE] = 0.14, p < 0.001) and very good within one rater ( = 0.82, SE = 0.12, p < 0.001) [17]. The interrater reliability for the MMAS was very good when evaluating wrist flexor spasticity in 30 patients with hemiplegia (weighted kappa [ w ] = 0.92, SE = 0.03, p < 0.001) [18]. In a study to investigate the interrater reliability of the MMAS in the assessment of elbow flexor spasticity, inexperienced raters tested 21 adult patients with stroke.…”

Validação do instrumento de medida da resistência da musculatura espástica flexora de punho e dedos

“…Sua importância mostra-se relevante para conhecer a eficácia das intervenções terapêuticas ou orientar as decisões de tratamento (NAGHDI et al, 2008).…”

“…A espasticidade é um problema de longo prazo e, para o desenvolvimento de programas de reabilitação efetivos, é fundamental a realização de ensaios rigorosos onde os instrumentos utilizados têm se mostrado imprescindíveis para orientar as decisões de tratamento e para medir o progresso em pacientes com espasticidade (NAGHDI et al, 2008).…”