title: Modified Ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation.
abstract: METHODS
  Intra- and inter-rater reliability study.
  
  
  OBJECTIVE
  To assess intra- and inter-rater reliability of the Modified Ashworth Scale (MAS) and Spasm Frequency Score (SFS) in lower extremities in a population of spinal cord-injured persons, as well as correlations between the two scales.
  
  
  METHODS
  Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbaek, Denmark.
  
  
  METHODS
  Thirty-one persons participated in the study and were tested four times in total with MAS and SFS by three experienced raters. Cohen's kappa (κ), simple and quadratic weighted (nominal and ordinal scale level of measurement), was used as a measure of reliability and Spearman's rank correlation coefficient for correlation between MAS and SFS.
  
  
  RESULTS
  Neurological level ranged from C2 to L2 and American Spinal Injury Association impairment scale A to D. Time since injury was (mean±s.d.) 3.4±6.5 years. Age was 48.3±20.2 years. Cause of injury was traumatic in 55% and non-traumatic for 45% of the participants. Antispastic medication was used by 61%. MAS showed intra-rater κsimple=-0.11 to 0.46 and κweighted=-0.11 to 0.83. Inter-rater κsimple=-0.06 to 0.32 and κweighted=0.08 to 0.74. SFS showed intra-rater κweighted=0.94 and inter-rater κweighted=0.93. Correlation between MAS and SFS showed non-significant correlation coefficients from-0.11 to 0.90.
  
  
  CONCLUSIONS
  Reliability of MAS is highly affected by the weighting scheme. With a weighted-κ it was overall reliable and simple-κ overall unreliability. Repeated tests should always be performed by the same rater and in a very standardized manner. SFS was found reliable. MAS and SFS are poorly correlated, and ratings were inversely distributed and suggest that it assesses different aspects of spasticity.
authors: Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark.
authors: C B
authors: CB
authors: Baunsgaard
authors: Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark.
authors: U V
authors: UV
authors: Nissen
authors: Department of Public Health, Section of Biostatistics, University of Copenhagen, Hornbaek, Denmark.
authors: K B
authors: KB
authors: Christensen
authors: Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark.
authors: F
authors: F
authors: Biering-Sørensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications*; D018709:Statistics, Nonparametric; D055815:Young Adult