Kaya Taciser, Karatepe Altinay Goksel, Gunaydin Rezzan, Koc Aysegul, Altundal Ercan Ulku
Department of Physical Therapy and Rehabilitation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Int J Rehabil Res. 2011 Mar;34(1):59-64. doi: 10.1097/MRR.0b013e32833d6cdf.
The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade '1+' of the MAS and redefining grade '2'. The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity. Sixty-four patients with poststroke hemiplegia were enrolled. The mean age and time since the stroke were 60.5 ± 11.9 years and 15.7 ± 10.2 weeks, respectively. The patients were tested by two raters having equal experience in applying MAS. They were not subjected to any training for administering MMAS. After performing no more than two test movements, the raters graded the resistance felt, according to the MAS and MMAS, respectively based on same stretch. The degree of agreement was analyzed using the weighted kappa (kw) statistic. Inter-rater agreements were very good for both MAS and MMAS, with weighted kappa values of 0.868 and 0.892, respectively. The highest agreements were observed for grade '0' in applying MAS and for grade '2' in applying MMAS; on the other hand, the lowest agreements were observed for grade '2' in applying MAS and for grade '3' in applying MMAS. According to our results, MAS and MMAS have very good inter-rater reliability for assessment of poststroke elbow flexor spasticity. Neither of the scales is superior to each other when using them to grade spasticity in patients with hemiplegia for this muscle group.
改良Ashworth量表（MAS）在临床实践中常用于评定痉挛程度。然而，最近该量表进行了修订，省略了MAS的“1+”级，并重新定义了“2”级。本研究旨在探讨MAS和改良MAS（MMAS）在评估脑卒中后肘屈肌痉挛时的评分者间信度。纳入64例脑卒中后偏瘫患者。患者的平均年龄和卒中后时间分别为60.5±11.9岁和15.7±10.2周。由两名在应用MAS方面经验相当的评分者对患者进行测试。他们未接受任何关于实施MMAS的培训。在进行不超过两次测试动作后，评分者根据MAS和MMAS，分别基于相同的伸展动作对感觉到的阻力进行评分。使用加权kappa（kw）统计量分析一致性程度。MAS和MMAS的评分者间一致性均非常好，加权kappa值分别为0.868和0.892。在应用MAS时，“0”级的一致性最高；在应用MMAS时，“2”级的一致性最高。另一方面，在应用MAS时，“2”级的一致性最低；在应用MMAS时，“3”级的一致性最低。根据我们的结果，MAS和MMAS在评估脑卒中后肘屈肌痉挛时具有非常好的评分者间信度。在对该肌肉群偏瘫患者进行痉挛分级时，两种量表均无明显优势。
