Advertisement

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

  • Allison Brashear
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Ross Zafonte
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Michael Corcoran
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Nestor Galvez-Jimenez
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Jean-Michel Gracies
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Mark Forrest Gordon
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Anita Mcafee
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Kyle Ruffing
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Barbara Thompson
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Michael Williams
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Chia-Ho Lee
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author
  • Catherine Turkel
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN (Brashear, Mcafee); University of Pittsburgh, PA (Zafonte); University of Maryland Medical System, Kernan Hospital, Baltimore, MD (Corcoran); Cleveland Clinic Florida, Weston, FL (Galvez-Jimenez); Mount Sinai School of Medicine, New York, NY (Gracies); Long Island Jewish Medical Center, New Hyde Park, NY (Gordon); Indiana University Hospital, Indianapolis, IN (Mcafee, Thompson, Williams); Neurological Research Institute of Sarasota, FL (Ruffing); and Allergan Inc, Irvine, CA (Lee, Turkel)
    Search for articles by this author

      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

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Young RR
        • Wiegner AW.
        Spasticity.
        Clin Orthop. 1987;Jun; : 50-62
        • Katz RT
        • Rymer WZ.
        Spastic hypertonia: mechanisms and measurement.
        Arch Phys Med Rehabil. 1989; 70: 144-155
        • Bajd T
        • Bowman B.
        Testing and modeling of spasticity.
        J Biomed Eng. 1982; 4: 90-96
        • Bajd T
        • Bowman B.
        Pendulum testing of spasticity.
        J Biomed Eng. 1984; 6: 9-16
        • Ashworth B.
        Preliminary trial of carisoprodol in multiple sclerosis.
        Practitioner. 1964; 192: 540-542
        • Alfieri V.
        Electrical treatment of spasticity: reflex tonic activity in hemiplegic patients and selected specific electrostimulation.
        Scand J Rehabil Med. 1982; 14: 177-182
        • World Medical Assembly
        The Declaration of Helsinki: recommendations guiding physicians in biomedical research involving human patients.
        World Med J. 1982; 29: 86-88
        • Siegel S
        • Castellan N.
        Nonparametric statistics for the behavioral sciences.
        in: 2nd ed. McGraw-Hill, New York1988: 284-291
        • Fleiss JL.
        Statistical methods of rates and proportions.
        in: 2nd ed. Wiley & Sons, New York1981: 38-46
        • Lance JW.
        The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture.
        Neurology. 1980; 30: 1303-1313
        • Gracies JM
        • Marosszeky JE
        • Renton R
        • Sandanam J
        • Gandevia SC
        • Burke D.
        Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients.
        Arch Phys Med Rehabil. 2000; 81: 1547-1555
        • Hinderer SR
        • Gupta S.
        Functional outcome measures to assess interventions for spasticity.
        Arch Phys Med Rehabil. 1996; 77: 1083-1089
        • Gregson JM
        • Leathley M
        • Moore AP
        • Sharma AK
        • Smith TL
        • Watkins CL.
        Reliability of the Tone Assessment Scale and the modified Ashworth Scale as clinical tools for assessing poststroke spasticity.
        Arch Phys Med Rehabil. 1999; 80: 1013-1016
        • Pandyan AD
        • Price CIM
        • Barnes MP
        • Rodgers H.
        A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity.
        Clin Rehabil. 1999; 13: 373-383
        • Lee K-C
        • Carson L
        • Kinnin E
        • Patterson V.
        The Ashworth Scale: a reliable and reproducible method of measuring spasticity.
        J Neuro Rehabil. 1989; 3: 205-209
        • Bohannon RW
        • Smith MB.
        Interrater reliability of a modified Ashworth scale of muscle spasticity.
        Phys Ther. 1987; 67: 206-207
        • Haas BM
        • Bergstom E
        • Jamous A
        • Bennie A.
        The interrater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury.
        Spinal Cord. 1996; 34: 560-564
        • Skold C.
        Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes.
        Arch Phys Med Rehabil. 2000; 81: 144-149
        • Bohannon RW
        • Warren ME
        • Cogman KA.
        Motor variables correlated with the hand-to-mouth maneuver in stroke patients.
        Arch Phys Med Rehabil. 1991; 72: 682-684
        • Mahoney FI
        • Barthel DW.
        Functional evaluation: the Barthel Index.
        Md State Med J. 1965; 14: 61-65
        • Feldman AB
        • Haley SM
        • Coryell J.
        Concurrent and construct validity of the Pediatric Evaluation of Disability Inventory.
        Phys Ther. 1990; 70: 602-610
        • Harvey RF
        • Jellinek HM.
        Functional performance assessment: a program approach.
        Arch Phys Med Rehabil. 1981; 62: 456-460
        • Taricco M
        • Apolone G
        • Colombo C
        • Filardo G
        • Telaro E
        • Liberati A.
        Functional status in patients with spinal cord injury: a new standardized measurement scale. Gruppo Interdisciplinare Valutazione Interventi Riabilitativi.
        Arch Phys Med Rehabil. 2000; 81: 1173-1180
        • Brashear A
        • Gordon MF
        • Elovic E
        • et al.
        A multicenter, double-blind, randomized, placebo-controlled, parallel study of the safety and efficacy of Botox (botulinum toxin type A) purified neurotoxin complex in the treatment of focal upper limb spasticity post-stroke.
        Neurology. 2001; 56 ([abstract]): A78