Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility.
METHODS
Comprehensive review and systematic analyses.


OBJECTIVE
Assess published psychometric evidence for spinal cord injury (SCI) spasticity outcome measures. Considerations about the influence of spasticity on function have also been identified to understand treatment effects and guide service delivery.


METHODS
London, Ontario and Vancouver, British Columbia, Canada.


METHODS
Review of measures was based on availability of psychometric data, application in clinical settings and evaluated in SCI patients.


RESULTS
Ashworth and Modified Ashworth Scales (AS, MAS), Penn Spasm Frequency Scale (PSFS), Spinal Cord Assessment Tool for Spasticity (SCATS), Visual Analogue Scale self-rated scale of spasticity (VAS) and the Wartenberg Pendulum Test (WPT) were included in this review. The most frequently used tools for SCI spasticity measurement include the AS, MAS, PSFS and VAS, of which the latter two are self-report spasticity measures. The SCATS has been partially validated for SCI, but is not widely used. The WPT has been minimally validated despite its use in a large-scale SCI spasticity randomized controlled trial.


CONCLUSIONS
Since spasticity is multidimensional, focusing on one or two spasticity outcome measures can misrepresent the extent and influence of spasticity on SCI patients. Different scales measure different aspects of spasticity and individual tools correlate weakly with each other. Spasticity may be better measured with an appropriate battery of tests, including the AS or MAS, along with PSFS. These tools would benefit from further reliability and responsiveness testing. Tools that assess the influence of spasticity on patient activities, participation and quality of life are important, but lacking.
Hsieh
J T C
JT
Lawson Health Research Institute, Aging Rehabilitation and Geriatric Care, London, Ontario, Canada. j.hsieh@sympatico.ca
Wolfe
D L
DL
Miller
W C
WC
Curt
A
A
D006801:Humans; D009128:Muscle Spasticity / Q000209:etiology*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011594:Psychometrics; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications*