Measurement of lower-limb muscle spasticity: intrarater reliability of Modified Modified Ashworth Scale

J Rehabil Res Dev. 2011;48(1):83-8. doi: 10.1682/jrrd.2010.02.0020.


The Modified Modified Ashworth Scale (MMAS) is a clinical instrument for measuring spasticity. Few studies have been performed on the reliability of the MMAS. The aim of the present study was to investigate the intrarater reliability of the MMAS for the assessment of spasticity in the lower limb. We conducted a test-retest study on spasticity in the hip adductors, knee extensors, and ankle plantar flexors. Each patient was measured by a hospital-based clinical physiotherapist. Twenty-three patients with stroke or multiple sclerosis (fourteen women, nine men) and a mean +/- standard deviation age of 37.3 +/- 14.1 years participated. The weighted kappa was moderate for the hip adductors (weighted kappa = 0.45, standard error [SE] = 0.16, p = 0.007), good for the knee extensors (weighted kappa = 0.62, SE = 0.12, p < 0.001), and very good for the ankle plantar flexors (weighted kappa = 0.85, SE = 0.05, p < 0.001). The kappa value for overall agreement was very good (weighted kappa = 0.87, SE = 0.03, p < 0.001). The reliability for the ankle plantar flexors was significantly higher than that for the hip adductors. The intrarater reliability of the MMAS in patients with lower-limb muscle spasticity was very good, and it can be used as a measure of spasticity over time.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Female
  • Humans
  • Iran
  • Lower Extremity
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Multiple Sclerosis / rehabilitation
  • Muscle Spasticity / etiology
  • Muscle Spasticity / physiopathology*
  • Muscle Spasticity / rehabilitation
  • Neurologic Examination / methods*
  • Observer Variation
  • Predictive Value of Tests
  • Recovery of Function / physiology*
  • Reproducibility of Results
  • Severity of Illness Index
  • Stroke / complications*
  • Stroke Rehabilitation
  • Young Adult