Validity and reliability of the Modified Tardieu Scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis

Abstract

PurposeTo evaluate published evidence on the Modified Tardieu Scale (MTS) as a tool to assess spasticity in the upper limbs of adults with neurological conditions.Data sourcesA systematic search of six electronic databases (PubMed/MEDLINE, CINAHL, EMBASE, the Cochrane Library, Web of Science and Physiotherapy Evidence Database) from inception to 31 December 2020. A search strategy was developed using key elements of the research question: population, intervention (action), outcome.Study eligibility criteriaInclusion criteria: (1) adult participants with neurological conditions; (2) upper limb muscles/joints as tested elements; (3) studies testing the MTS and (4) reliability or validity reported. Exclusion criteria: (1) non-English articles; (2) non-empirical articles and (3) studies testing the Tardieu Scale.Study appraisalEvidence quality was evaluated using the US National Heart, Lung, Blood Institute quality assessment tool for observational cohort and cross-sectional studies.ResultsSix reliability studies met the inclusion criteria. Overall, most articles reported good-to-excellent levels of inter-rater, intrarater and test–retest reliability. However, limitations, such as study design weaknesses, statistical misuses and reporting biases, undermine confidence in reported conclusions. The validity of the MTS also remained questionable based on the results of one study.Conclusions and implicationsThis review did not find sufficient evidence to either support or reject the use of the MTS in assessing spasticity in the upper limbs of adults with neurological conditions. Despite the paucity of research evidence, the MTS may still remain a clinically useful tool to measure the motor aspect of spasticity. Future research would benefit from a focus on test standardisation, while the wider field would require the development of a consensual definition of spasticity.

Current clinical practice of Irish physiotherapists and occupational therapists in the assessment and treatment of spasticity in adults

“…Range of Motion (ROM) and Modified Ashworth Scale (MAS) are the most commonly used standardised assessment tools with the MAS being the preferred scale over the Tardieu scale (TS). This is similar to other research which reports MAS is the most commonly used spasticity outcome measure used (Shu et al , 2021; Marciniak, 2011; Blanchette et al , 2017). This is despite the fact that the validity and reliability of the MAS have been questioned as ratings are subjective and capture passive resistance to stretch only (Hugos and Cameron, 2019; Dehem et al , 2017; Thompson et al , 2005).…”

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

“…In general, MAS reliability and validity are adequate, especially when spasticity is evaluated by trained medical professionals as in the studies of our meta-analysis [67,68]. Yet, other scales such as the Modified Tardieu Scale (MTS) have been shown to have a better construct validity [69][70][71]. Despite any drawbacks, MAS is the most widely used assessment scale of spasticity in clinical practice and was the most commonly used scale by authors.…”

Measuring Mechanical Properties of Spastic Muscles After Stroke. Does Muscle Position During Assessment Really Matter?

“…Participants should have at least a slight increase of biceps brachii and gastrocnemius muscle tone. This was identified with a score ≥1 in the Modified Ashworth Scale, 11 which addresses the involuntary muscle activation feature of spasticity 12 as the resistance to a passive movement. 13 The exclusion criteria were as follows: cognitive impairtment (score >24 in the Mini-Mental State Examination), 14 diagnosed mood disorder or other neurologic condition, prior severe upper or lower limb trauma, changes in medication for PSS in the previous 48 hours, treatment with botulinum toxin injections within 12 weeks or during the study period, and an epileptic crisis during the previous week.…”