Haas B M, Bergström E, Jamous A, Bennie A
University of Brighton, Department of Occupational Therapy and Physiotherapy, Aylesbury, Bucks, UK.
Spinal Cord. 1996 Sep;34(9):560-4. doi: 10.1038/sc.1996.100.
Thirty patients with spinal cord injury (SCI) were randomly selected to participate in this study which evaluated the inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in the lower limbs. A doctor and a physiotherapist rated the muscle tone of hip adductors, hip extensors, hip flexors and ankle plantarflexors according to the original and to the modified Ashworth scale. The results were analyzed using a Cohen's Kappa statistical test and showed varying levels of reliability for different muscle groups and limbs. Kappa values ranged between 0.21 and 0.61 (mean 0.37). The original scale was slightly more reliable than was the modified scale. However, this difference was not significant (P > 0.05), and was not consistent between the two limbs and between different muscle groups. It was concluded that the Ashworth scale is of limited use in the assessment of spasticity in the lower limb of patients with SCI. Further work is required to establish a standardised speed of muscle stretching during the test, or to find more appropriate grades and descriptions of spasticity for this patient group. The effects of training of the raters in the use of the scales also warrants further investigation.
随机选取30例脊髓损伤（SCI）患者参与本研究，该研究评估了原始版和改良版Ashworth量表在评估下肢痉挛方面的评分者间信度。一名医生和一名物理治疗师根据原始版和改良版Ashworth量表对髋内收肌、髋伸肌、髋屈肌和踝跖屈肌的肌张力进行评分。结果采用Cohen's Kappa统计检验进行分析，结果显示不同肌肉群和肢体的信度水平各不相同。Kappa值在0.21至0.61之间（平均0.37）。原始量表比改良量表稍可靠一些。然而，这种差异并不显著（P>0.05），且在双下肢和不同肌肉群之间并不一致。研究得出结论，Ashworth量表在评估SCI患者下肢痉挛方面的用途有限。需要进一步开展工作，以确定测试期间肌肉拉伸的标准化速度，或为该患者群体找到更合适的痉挛分级和描述。评分者使用量表培训的效果也值得进一步研究。
