title: Intra- and interrater reliability of the Modified Tardieu Scale for the assessment of lower limb spasticity in adults with neurologic injuries.
abstract: OBJECTIVE
  To examine the intra- and interrater reliability of the Modified Tardieu Scale (MTS) for lower limb assessment of adults with chronic neurologic injuries.
  
  
  METHODS
  Single-center intra- and interrater reliability study.
  
  
  METHODS
  Outpatient neurorehabilitation unit.
  
  
  METHODS
  Adults (N=30; mean age ± SD, 54.1±12.5y) with various chronic neurologic injuries and lower limb spasticity.
  
  
  METHODS
  Two experienced physiotherapists performed slow (R2) and fast (R1) passive movements for lower limb muscles half an hour apart on the same day (interrater reliability), while a third physiotherapist took goniometric measurements only. One physiotherapist repeated the assessment 1 to 3 days earlier or later (intrarater reliability). Assessors qualitatively rated the resistance to fast passive movements.
  
  
  METHODS
  Intraclass correlation coefficients (ICCs) and limits of agreement (LOA) were calculated for R1, R2, and R2-R1. Kappa coefficients were calculated for tibialis range of movement and qualitative spasticity ratings.
  
  
  RESULTS
  Intra- and interrater R1 and R2 measurements showed moderate to high reliability for the affected hamstrings, rectus femoris, gastrocnemius, soleus (mean ICC ± SD, .79±.08), and tibialis anterior (mean κ ± SD, .58±.10). Only intrarater measurements of the affected tibialis posterior were moderately reliable (R1=.57, R2=.77). Seven of 16 spasticity angle measurements of the affected muscles were moderately reliable. LOA were mostly unacceptably wide. Qualitative spasticity ratings were moderately reliable for affected hamstrings, gastrocnemius, and tibialis muscles (mean κ ± SD, .52±.10).
  
  
  CONCLUSIONS
  The MTS is reliable for assessing spasticity in most lower limb muscles of adults with chronic neurologic injuries. Repeated MTS measurements of spasticity are best based on R1 measurements rather than spasticity angle or qualitative ratings of spasticity. Optimally, MTS measurements should be undertaken by the same clinician.
authors.affiliation: Caulfield Hospital, Melbourne, Victoria, Australia. Electronic address: E.Ben-Shabat@alfred.org.au.
authors.forename: Ettie
authors.initials: E
authors.lastname: Ben-Shabat
authors.affiliation: Caulfield Hospital, Melbourne, Victoria, Australia.
authors.forename: Mithu
authors.initials: M
authors.lastname: Palit
authors.affiliation: Caulfield Hospital, Melbourne, Victoria, Australia.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Fini
authors.affiliation: Caulfield Hospital, Melbourne, Victoria, Australia.
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Brooks
authors.affiliation: Caulfield Hospital, Melbourne, Victoria, Australia.
authors.forename: Adele
authors.initials: A
authors.lastname: Winter
authors.affiliation: Alfred Health, Melbourne, Victoria, Australia; La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology*; D009422:Nervous System Diseases / Q000503:physiopathology*; D009460:Neurologic Examination / Q000379:methods; D015203:Reproducibility of Results
keywords: Adult; ICC; LOA; MTS; Modified Tardieu Scale; Muscle spasticity; Muscle tone increased; R1; R2; Rehabilitation; Reproducibility of results; angle of full, slow passive range of movement; angle of resistance first felt during fast passive movements; intraclass correlation coefficient; limits of agreement