Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury

a comparison study

Mehrholz, Jan
Wagner, Katja
Meiner, Daniel
Grundmann, Kay
Zange, Christian
Koch, Rainer
Pohl, Marcus

Department of Early Rehabilitation, Klinik Bavaria, Kreischa (Mehrholz, Wagner, Meißner, Grundmann, Zange)
Institute for Medical Informatics and Biometrics of the Technical University Dresden and (Koch)
Department of Early Rehabilitation, Klinik Bavaria, Kreischa, Germany (Pohl)

Address for correspondence: Marcus Pohl, Department of Early Rehabilitation, Klinik Bavaria, An der Wolfsschlucht 1–2, D-01731 Kreischa, Germany. e-mail: [email protected]

Received 24th August 2004; returned for revisions 5th January 2005; revised manuscript accepted 13th February 2005

Clinical Rehabilitation 19(7):p 751-759, July 2005.

Objective

To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness.

Design

Cross-sectional observational comparison study.

Setting

An early rehabilitation centre for adults with neurological disorders.

Subjects

Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies.

Measurement protocol

Four experienced physical therapists rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, hip, knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures.

Main outcome measures

Test-retest and inter-rater reliability (K = kappa value) of the Modified Tardieu Scale and the Modified Ashworth Scale.

Results

The test-retest reliability of the Modified Ashworth Scale was moderate to good (κ = 0.47–0.62) and of the Modified Tardieu Scale moderate to very good (κ = 0.52–0.87). Test-retest reliability was significantly higher within the Modified Tardieu Scale in comparison with the Modified Ashworth Scale (Z< 1.96; p<0.05) except for shoulder extensor and internal rotator muscles (Z< 1.96; p>0.05). Although inter-rater reliability of both scales was poor to moderate (Modified Ashworth Scale: κ = 0.16–0.42; Modified Tardieu Scale: κ = 0.29–0.53), significantly higher κ-values were revealed with the Modified Tardieu Scale for all tested muscle groups (Z> 1.96; p < 0.05) except for wrist extensors (Z< 1.96; p>0.05).

Conclusion

In patients with severe brain injury and impaired consciousness the Modified Tardieu Scale provides higher test-retest and inter-rater reliability compared with the Modified Ashworth Scale and may therefore be a more valid spasticity scale in adults.