Test-retest reliability and inter-rater reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in hemiplegic patients with stroke

Eur J Phys Rehabil Med. 2014 Feb;50(1):9-15. Epub 2013 Dec 5.


Background: The most commonly used tools for the assessment of spasticity are the Modified Ashworth Scale and Modified Tardieu Scale, but the results on the reliability of both scales keep equivocal.

Aim: To evaluate the test-retest reliability and inter-rater reliability of the Modified Tardieu Scale (MTS) and Modified Ashworth Scale (MAS) in hemiplegic patients with stroke.

Design: Cross-sectional study.

Setting: Inpatients referred to a rehabilitation hospital.

Population: Fifty-one inpatients with hemiplegic stroke.

Methods: MTS and MAS were collected from the affected elbow flexors and ankle plantar flexors by: 1) two raters who were blinded to the results of the other assessment. 2) one rater one day apart.

Results: In the MAS measurement, the inter-rater and intra-rater Kappa values were 0.66 and 0.69 for the elbow flexors, 0.48 and 0.48 for the plantar flexors, respectively. In the angle measurement of the MTS, the inter-rater and intra-rater ICCs were between 0.58-0.89 for the R1 and R2, and between 0.62-0.70 for the R1-R2.

Conclusion: The MAS provided moderate to substantial test-retest reliability and inter-rater reliability in the spasticity/tone measurement. The agreement of MAS elbow flexors scores was higher than that of plantar flexors scores. The reliability of angle measurement in the MTS was insufficient.

Clinical rehabilitation impact: Further work should avoid observing error when taking advantage of angle difference on measuring spasticity.

MeSH terms

  • Ankle Joint / physiopathology*
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Elbow Joint / physiopathology*
  • Female
  • Follow-Up Studies
  • Hemiplegia / complications*
  • Hemiplegia / physiopathology
  • Hemiplegia / rehabilitation
  • Humans
  • Male
  • Middle Aged
  • Muscle Spasticity / etiology
  • Muscle Spasticity / physiopathology*
  • Muscle Spasticity / rehabilitation
  • Muscle Tonus / physiology*
  • Range of Motion, Articular / physiology
  • Reproducibility of Results
  • Stroke / complications*
  • Stroke / physiopathology
  • Stroke Rehabilitation