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

154 Citations (Scopus)

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

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Upper Extremity
Thumb
Bandages
Elbow
Wrist
Hygiene
Posture
Fingers
Extremities
Stroke
Outcome Assessment (Health Care)
Pain

Keywords

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

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. / Brashear, Allison; Zafonte, Ross; Corcoran, Michael; Galvez-Jimenez, Nestor; Gracies, Jean Michel; Gordon, Mark Forrest; McAfee, Anita; Ruffing, Kyle; Thompson, Barbara; Williams, Michael; Lee, Chia Ho; Turkel, Catherine.

In: Archives of Physical Medicine and Rehabilitation, Vol. 83, No. 10, 10.2002, p. 1349-1354.

Research output: Contribution to journalArticle

Brashear, A, Zafonte, R, Corcoran, M, Galvez-Jimenez, N, Gracies, JM, Gordon, MF, McAfee, A, Ruffing, K, Thompson, B, Williams, M, Lee, CH & 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, vol. 83, no. 10, pp. 1349-1354. https://doi.org/10.1053/apmr.2002.35474
Brashear, Allison ; Zafonte, Ross ; Corcoran, Michael ; Galvez-Jimenez, Nestor ; Gracies, Jean Michel ; Gordon, Mark Forrest ; McAfee, Anita ; Ruffing, Kyle ; Thompson, Barbara ; Williams, Michael ; Lee, Chia Ho ; Turkel, Catherine. / Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. In: Archives of Physical Medicine and Rehabilitation. 2002 ; Vol. 83, No. 10. pp. 1349-1354.
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AU - Zafonte, Ross

AU - Corcoran, Michael

AU - Galvez-Jimenez, Nestor

AU - Gracies, Jean Michel

AU - Gordon, Mark Forrest

AU - McAfee, Anita

AU - Ruffing, Kyle

AU - Thompson, Barbara

AU - Williams, Michael

AU - Lee, Chia Ho

AU - Turkel, Catherine

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N2 - 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.

AB - 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.

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