音调评估量表和改良Ashworth量表作为评估脑卒中后痉挛的临床工具的可靠性。

Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity.

作者信息

Gregson J M, Leathley M, Moore A P, Sharma A K, Smith T L, Watkins C L

机构信息

Stroke Team for Audit and Research, University Hospital, Aintree, Liverpool, United Kingdom.

出版信息

Arch Phys Med Rehabil. 1999 Sep;80(9):1013-6. doi: 10.1016/s0003-9993(99)90053-9.

DOI:10.1016/s0003-9993(99)90053-9

PMID:10489001

Abstract

OBJECTIVES

To establish reliability of the Tone Assessment Scale and modified Ashworth scale in acute stroke patients.

SETTING

A North Liverpool university hospital.

PATIENTS

Eighteen men and 14 women admitted with acute stroke and still in hospital at the study start date (median age, 74 yrs; median Barthel score, 8).

MAIN OUTCOME MEASURES

The modified Ashworth scale and the Tone Assessment Scale.

STUDY DESIGN

The 32 patients were examined with both scales on the same occasion by two raters (interrater comparison) and on two occasions by one rater (intrarater comparison).

RESULTS

The reliability of the modified Ashworth scale was very good (kappa = .84 for interrater and .83 for intrarater comparisons). The reliability of the Tone Assessment Scale was not as strong as the modified Ashworth scale, with marked variability in the assessment of posture (kappa = .22 to .50 for interrater and .29 to .55 for intrarater comparisons) and associated reaction (kappa/kappaW = -.05 to .79 for interrater and .19 to .83 for intrarater comparisons). However, those aspects of the Tone Assessment Scale that addressed response to passive movement and that are scored similarly to the modified Ashworth scale showed good to very good interrater reliability (kappaW = .79 to .92) and good to very good intrarater reliability (kappaW = .72 to .86), except for the question related to movement at the ankle where agreement was only moderate (kappaW = .59).

CONCLUSIONS

The modified Ashworth scale is reliable. The section of the Tone Assessment Scale relating to response to passive movement is reliable at various joints, except the ankle. It may assist in studies on the prevalence of spasticity after stroke and the relationship between tone and function. Further development of a measure of spasticity at the ankle is required. The Tone Assessment Scale is not reliable for measuring posture and associated reactions.

摘要

目的

确立急性脑卒中患者肌张力评估量表及改良Ashworth量表的可靠性。

地点

北利物浦大学医院。

患者

18名男性和14名女性，因急性脑卒中入院，在研究开始日期仍住院（中位年龄74岁；中位Barthel评分8分）。

主要观察指标

改良Ashworth量表和肌张力评估量表。

研究设计

32例患者由两名评估者在同一时间使用两种量表进行检查（评估者间比较），并由一名评估者在两个不同时间进行检查（评估者内比较）。

结果

改良Ashworth量表的可靠性非常好（评估者间比较kappa = 0.84，评估者内比较kappa = 0.83）。肌张力评估量表的可靠性不如改良Ashworth量表，在姿势评估方面存在明显差异（评估者间比较kappa = 0.22至0.50，评估者内比较kappa = 0.29至0.55）以及相关反应方面（评估者间比较kappa/kappaW = -0.05至0.79，评估者内比较kappa/kappaW = 0.19至0.83）。然而，肌张力评估量表中涉及被动运动反应且评分与改良Ashworth量表相似的部分，显示出良好至极优的评估者间可靠性（kappaW = 0.79至0.92）和良好至极优的评估者内可靠性（kappaW = 0.72至0.86），除了与踝关节运动相关的问题，其一致性仅为中等（kappaW = 0.59）。