Ashworth量表和改良Ashworth量表在痉挛型脑瘫儿童中的可靠性
Reliability of Ashworth and Modified Ashworth scales in children with spastic cerebral palsy.
作者信息
Mutlu Akmer, Livanelioglu Ayse, Gunel Mintaze Kerem
机构信息
Hacettepe University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, 06100, Samanpazari, Ankara, Turkey.
出版信息
BMC Musculoskelet Disord. 2008 Apr 10;9:44. doi: 10.1186/1471-2474-9-44.
BACKGROUND
Measurement of spasticity is a difficult and unresolved problem, partly due to its complexity and the fact that there are many factors involved. In the assessment of spasticity in the pediatric disabled population, methods that are easily used in practice are ordinal scales that still lack reliability. A prospective cross-sectional observational study was planned to determine the reliability of the Ashworth Scale (AS) and the Modified Ashworth Scale (MAS) in children with spastic cerebral palsy (CP).
METHODS
The study included 38 children with spastic diplegic CP. The mean age for the children was 52.9 months (SD: 19.6) ranging from 18 to 108 months. The functional levels of children were classified according to the Gross Motor Function Classification System. 20 children were in Level II (52.6%), 18 were in Level III (47.4%) and 9 were in Level I (23.7%). Spasticity in hip flexors, adductors, internal rotators, hamstrings, gastrocnemius were assessed by AS and MAS. Each child was assessed by three physiotherapists in two different sessions, a week apart. The intrarater reliability was determined by paired comparison of measurements for each therapist for the two assessments. Interrater reliability was determined by paired comparisons of the three therapists' measurements on the same day. The inter and intrarater reliability of the scales were evaluated by the intraclass correlation coefficient (ICC).
RESULTS
According to ICC scores, interrater reliability of AS and MAS varied from moderate to good. ICC scores of AS were between 0.54 and 0.78 and MAS were between 0.61-0.87. Test-retest results of AS and MAS varied from poor to good. ICC values were between 0.31 and 0.82 for AS and between 0.36 and 0.83 for MAS.
CONCLUSION
The interrater and intrarater reliability of AS and MAS are related to muscle and joint characters. The repetition of measurements by the same physiotherapist, and experience may not affect reliability. These scales are not very reliable and assessments of spasticity using these scales should be therefore interpreted with great caution.
背景
痉挛的测量是一个困难且尚未解决的问题，部分原因在于其复杂性以及涉及诸多因素。在评估残疾儿童的痉挛情况时，实践中易于使用的方法是仍缺乏可靠性的序数量表。一项前瞻性横断面观察性研究旨在确定Ashworth量表（AS）和改良Ashworth量表（MAS）在痉挛型脑性瘫痪（CP）儿童中的可靠性。
方法
该研究纳入了38名痉挛型双瘫CP儿童。儿童的平均年龄为52.9个月（标准差：19.6），年龄范围在18至108个月之间。儿童的功能水平根据粗大运动功能分类系统进行分类。20名儿童处于二级（52.6%），18名处于三级（47.4%），9名处于一级（23.7%）。通过AS和MAS评估髋屈肌、内收肌、内旋肌、腘绳肌、腓肠肌的痉挛情况。每个儿童由三名物理治疗师在两个不同时段进行评估，间隔一周。通过对每位治疗师两次评估的测量结果进行配对比较来确定评分者内信度。通过对三名治疗师在同一天的测量结果进行配对比较来确定评分者间信度。量表的评分者间和评分者内信度通过组内相关系数（ICC）进行评估。
结果
根据ICC评分，AS和MAS的评分者间信度从中度到良好不等。AS的ICC评分在0.54至0.78之间，MAS的ICC评分在0.61 - 0.87之间。AS和MAS的重测结果从差到良好不等。AS的ICC值在0.31至0.82之间，MAS的ICC值在0.36至0.83之间。
结论
AS和MAS的评分者间和评分者内信度与肌肉和关节特征有关。同一名物理治疗师重复测量以及经验可能不会影响信度。这些量表不是非常可靠，因此使用这些量表对痉挛进行评估时应极其谨慎地解读。
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