Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity,☆☆,,★★,

https://doi.org/10.1053/apmr.2002.35474Get rights and content

Abstract

Brashear A, Zafonte R, Corcoran M, Galvez-Jimenez N, Gracies J-M, Gordon MF, Mcafee A, Ruffing K, Thompson B, Williams M, Lee C-H, Turkel C. Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Arch Phys Med Rehabil 2002;83:1349-54. Objective: To evaluate the reliability of the Ashworth Scale and the Disability Assessment Scale (DAS) in poststroke patients with upper-limb spasticity and functional disability. Design: Single-center trial. Setting: University medical center. Participants: Nine patients ≥6 months poststroke with upper-limb spasticity and impairment in the areas of hygiene, dressing, limb posture, or pain were included in the analysis. Interventions: Ten experienced medical professionals rated each patient in randomized order twice on the same day (results based on mean of evaluations at times 1 and 2). Elbow, wrist, finger, and thumb flexion tones were assessed by using the Ashworth score (range, 0–4), and functional disability was assessed using the DAS (range, 0–3). Main Outcome Measures: Intra- and interrater reliability of the Ashworth Scale and DAS. Results: For the Ashworth parameters, 38 of 40 evaluations indicated excellent (weighted κ≥.75) or good (weighted κ≥.4) intrarater reliability. For DAS parameters, 31 of 40 evaluations indicated excellent or good intrarater reliability. The interrater reliability was also good for both the Ashworth Scale (Kendall W=.598–.792) and DAS (Kendall W=.494–.772) with statistically significant agreement found among raters (all P<.001). Conclusions: In patients with upper-limb spasticity after stroke, the Ashworth Scale and DAS had good intra- and interrater reliability when used by trained medical professions. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Participants

Ten patients with upper-limb spasticity were recruited for this single-center trial. Patients were required to be at least 21 years of age; to have a documented history of stroke that resulted in spasticity of the elbow, wrist, finger, and/or thumb flexors in at least 1 limb; and to have some degree of impairment pertaining to hygiene, dressing, limb position, or pain.

The protocol excluded patients who had experienced a stroke within 6 months of study enrollment, had a cast on the affected

Patient characteristics

Ten patients were screened, entered the study, and completed both evaluations. One patient was reported as having a major protocol deviation (ie, he had taken a dose of antispasticity medication on the morning of the study day). Data for this patient were not included in the analysis.

Demographic characteristics of the study population are provided in table 1.

. Patients' demographic characteristics (N=9)

Age (y)
 Mean ± SD59.9±16.17
 Median69
 Range37–81
Gender
 Men5 (55.6%)
 Women4 (44.4%)
Race
 White6 (66.7%)
 

Discussion

Quantification of muscle tone and associated impairment remains a clinical challenge due to the intricate relationship of this feature with other complications of the upper motoneuron syndrome (eg, muscle contracture, spastic dystonia).10 Over the past several years, numerous methods have been developed to provide information about the resistance of the spastic limb to passive joint movement.3, 11 Although some of these methods have proven useful for assessing functional outcomes of patients

Conclusion

This study showed that the Ashworth Scale and the DAS have good intra- and interrater reliability when used by trained medical professionals to rate excessive tone and functional impairment in patients with upper-limb spasticity after stroke. These scales can be used readily in the clinical setting.

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    Supported by Allergan Inc (grant no. 45-843-14).

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Allison Brashear, MD, Indiana University Medical Ctr, 550 University Blvd, Rm 6620, Indianapolis, IN 46202-5167, e-mail: [email protected].

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