Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity

Allison Brashear, Ross Zafonte, Michael Corcoran, Nestor Galvez-Jimenez, Jean Michel Gracies, Mark Forrest Gordon, Anita McAfee, Kyle Ruffing, Barbara Thompson, Michael Williams, Chia Ho Lee, Catherine Turkel

Research output: Contribution to journalArticle

165 Scopus citations

Abstract

Objective: To evaluate the reliability of the Ashworth Scale and the Disability Assessment Scale (DAS) in poststroke patients with upper-limb spasticity and functional disability. Design: Single trial. Setting: University medical center. Participants: Nine patients ≥6 months poststroke with upper-limb spasticity and impairment in the areas of hygiene, dressing, limb posture, or pain were included in the analysis. Interventions: Ten experienced medical professionals rated each patient in randomized order twice on the same day (results based on mean of evaluations at times 1 and 2). Elbow, wrist, finger, and thumb flexion tones were assessed by using the Ashworth score (range, 0-4), and functional disability was assessed using the DAS (range 0-3). Main Outcome Measures: Intra- and interrater reliability of the Ashworth Scale and DAS. Results: For the Ashworth parameters, 38 of 40 evaluations indicated excellent (weighted κ≥.75) or good (weighted κ≥.4) intrarater reliability. For DAS parameters, 31 of 40 evaluations indicated excellent or good intrarater reliability. The interrater reliability was also good for both the Ashworth Scale (Kendall W=.598-.792) and DAS (Kendall W=.494-.772) with statistically significant agreement found among raters (all P<.001). Conclusions: In patients with upper-limb spasticity after stroke, the Ashworth Scale and DAS had good intra- and interrater reliability when used by trained medical professions.

Original languageEnglish (US)
Pages (from-to)1349-1354
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Volume83
Issue number10
DOIs
StatePublished - Oct 2002
Externally publishedYes

Keywords

  • Cerebrovascular accident
  • Muscle spasticity
  • Outcome assessment (health care)
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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    Brashear, A., Zafonte, R., Corcoran, M., Galvez-Jimenez, N., Gracies, J. M., Gordon, M. F., McAfee, A., Ruffing, K., Thompson, B., Williams, M., Lee, C. H., & Turkel, C. (2002). Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Archives of Physical Medicine and Rehabilitation, 83(10), 1349-1354. https://doi.org/10.1053/apmr.2002.35474