title: Development of the Persian version of the Modified Modified Ashworth Scale: translation, adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity.
abstract: OBJECTIVE
  Development of the Persian version of the Modified Modified Ashworth Scale (MMAS), and to investigate the interrater and intrarater reliability of the Persian MMAS when used to quantify elbow flexor spasticity in patients after stroke.
  
  
  METHODS
  The Persian MMAS was developed by the forward and backward translation procedure, a final review by an expert committee, and testing for acceptability and the clarity of item wording so that the scale could be used by Persian-speaking examiners. Psychometric testing included interrater and intrarater reliability. Elbow flexor spasticity was examined by two raters in 30 patients after stroke twice on two occasions using the Persian MMAS. The weighted κ was used for the statistical analysis.
  
  
  RESULTS
  The interrater and intrarater reliability was very good for the Persian MMAS (weighted κ: 0.81-0.91; 95% CI 0.68-0.98) with statistically significant agreement between raters and within raters (all p < 0.001).
  
  
  CONCLUSIONS
  The Persian version of the MMAS was successfully developed. The Persian MMAS showed very good interrater and intrarater reliability in patients with elbow flexor spasticity after stroke. The results support the use of the Persian version of the MMAS both in clinical and research settings.
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran. nakhostin@sina.tums.ac.ir
authors.forename: Noureddin
authors.initials: N
authors.lastname: Nakhostin Ansari
authors.forename: Soofia
authors.initials: S
authors.lastname: Naghdi
authors.forename: Bijan
authors.initials: B
authors.lastname: Forogh
authors.forename: Scott
authors.initials: S
authors.lastname: Hasson
authors.forename: Mitra
authors.initials: M
authors.lastname: Atashband
authors.forename: Elham
authors.initials: E
authors.lastname: Lashgari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004551:Elbow Joint / Q000503:physiopathology*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D007492:Iran; D007802:Language; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology* / Q000534:rehabilitation; D015588:Observer Variation; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000295:instrumentation; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires / Q000592:standards*; D014175:Translating; D016896:Treatment Outcome