Reliability of Measurements Obtained With the Modified Ashworth Scale in the Lower Extremities of People With Stroke

Blackburn, Marjan; Vliet, Paulette van; Mockett, Simon

doi:10.1093/ptj/82.1.25

Cited by 247 publications

(155 citation statements)

References 19 publications

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“…Inter-rater reliability of two raters was poor (tÀb ¼ 0.062 for combined muscle group), and intra-rater reliability was satisfactory (tÀb ¼ 0.567). 24 Because of our study design and small sample size, we could not isolate whether the lack of agreement is due to variability in the subject's spasticity, the raters or the MAS tool. Despite having fair intra-rater reliability and poor interrater reliability, an inappropriate level of confidence has been placed in the MAS as a lower extremity spasticity measurement tool.…”

Section: Muscle Groupmentioning

confidence: 99%

“…Despite our attempts to reduce subject variability and standardize the testing method, 23,24 our results are consistent with those of Allison et al 23 and Blackburn et al 24 Allison et al 23 used the MAS to assess plantarflexor spasticity on 30 individuals with traumatic brain injury and found average intra-rater reliability (r ¼ 0.55 and 0.74; k ¼ 0.29 and 0.69; tÀb ¼ 0.48 and 0.67) and average inter-rater reliability (r ¼ 0.73; k ¼ 0.4; tÀb ¼ 0.65). 23 The poor reliability of the MAS when applied to the ankle was speculated as due to a short lever arm of the ankle making it more difficult to determine the resistance during movement.…”

Section: Muscle Groupmentioning

confidence: 99%

“…23 The poor reliability of the MAS when applied to the ankle was speculated as due to a short lever arm of the ankle making it more difficult to determine the resistance during movement. Blackburn et al 24 used the MAS to assess lower-limb muscle spasticity of 20 patients 2 weeks after stroke, and repeated the test on 12 of the patients at 12 weeks after stroke. Inter-rater reliability of two raters was poor (tÀb ¼ 0.062 for combined muscle group), and intra-rater reliability was satisfactory (tÀb ¼ 0.567).…”

Section: Muscle Groupmentioning

confidence: 99%

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Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

2009

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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.

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Section: Muscle Groupmentioning

confidence: 99%

Section: Muscle Groupmentioning

confidence: 99%

Section: Muscle Groupmentioning

confidence: 99%

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Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

2009

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“…16 The following muscles were assessed: hip adductors, hip extensors and flexors, knee extensors and flexors and ankle dorsiflexors and plantarflexors.…”

Section: Assessments and Outcome Measuresmentioning

confidence: 99%

No Specific Effect of Whole-Body Vibration Training in Chronic Stroke: A Double-Blind Randomized Controlled Study

Brogårdh¹,

Flansbjer²,

Lexell³

2012

Archives of Physical Medicine and Rehabilitation

146

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“…Performance-based: quality of walking (Walking Capability Scale (WCS)), 3,4 balance (Berg Balance Scale (BBS)), [22][23][24][25] walking speed (7-metre walking test), [26][27][28][29] and balance and mobility (Get up and Go test). 30,31 Body functions Spasms (Modified Ashworth Scale (MAS)) [32][33][34][35][36][37] and muscle strength (MicroFet). [38][39][40] Experimental intervention TT was given five times a week for 12 weeks and was adapted to the subject's physical abilities (maximum of five times a week, 30 min a session).…”

Section: Quality Of Lifementioning

confidence: 99%

Body weight-supported treadmill training in chronic incomplete spinal cord injury: a pilot study evaluating functional health status and quality of life

et al. 2005

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Study design: A controlled single-case design: A1 (baseline: 6 weeks), B (intervention: 12 weeks of treadmill training (TT), maximally five times a week/30 min a day), A2 (wash-out: 6 weeks), follow-up measurement: 6 months. Objective: To investigate the effects of TT on functional health status (FHS) and quality of life (QoL) in subjects with a chronic incomplete spinal cord injury (ISCI). Setting: Rehabilitation Department, University Medical Centre Utrecht, The Netherlands. Methods: Three male subjects with a stable (448 months postinjury) ISCI, American Spinal Injury Association (ASIA) class C (n ¼ 2) and D (n ¼ 1). Performance-based walking, subject's perception concerning quality of life (SEIQoL) and activities of daily living Canadian Occupational Performance Measure (COPM). Results: The results of the three subjects were variable. Changes in QoL were relatively small and diverse. After 6 months' follow-up, QoL was unchanged in subjects 1 and 2, and improved in subject 3. In subject 2, performance of activities of daily living (ADL) was significantly improved, consistent with his perception of improvement (Po0.05), and this improvement was sustained throughout the follow-up period. Walking ability improved in subject 3 (Po0.05) but performance of other activities remained stable. Performance of ADL decreased slightly in subject 1 whereas his walking speed and Get up and Go performance improved (Po0.05). Conclusions: This study demonstrates positive effects of TT on FHS. A randomised clinical trial should be executed before definite conclusions about the effect of TT on FHS and QoL can be drawn.

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Reliability of Measurements Obtained With the Modified Ashworth Scale in the Lower Extremities of People With Stroke

Abstract: The Modified Ashworth Scale yielded reliable measurements in the lower limb for a single examiner, and agreement was best on the grade of 0. The reliability between examiners was not good, which may bring into question the validity of measurements obtained with the scale.

Cited by 247 publications

References 19 publications

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

No Specific Effect of Whole-Body Vibration Training in Chronic Stroke: A Double-Blind Randomized Controlled Study

Body weight-supported treadmill training in chronic incomplete spinal cord injury: a pilot study evaluating functional health status and quality of life

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