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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2017 Sep 13

DOI: 10.23736/S1973-9087.17.04796-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis

Ana-Belén MESEGUER-HENAREJOS 1 , Julio SÁNCHEZ-MECA 2, José-Antonio LÓPEZ-PINA 2, Ricardo CARLES-HERNÁNDEZ 1

1 Department of Physiotherapy, University of Murcia, Murcia, Spain; 2 Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain


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INTRODUCTION: The Modified Ashworth Scale is the most widely clinical scale used to measure the increase of muscle tone. Reliability is not an immutable property of a scale and can vary as a function of the variability and composition of the sample to which it is administered. The best method to examine how the reliability of a test scores varies is by conducting a systematic review and meta-analysis of the reliability coefficients obtained in different applications of the test with the data at hand. The objectives of this systematic revision are: What is the mean inter- and intra-rater reliability of the Modified Ashworth Scale’s scores in upper and lower extremities? Which study characteristics affect the reliability of the scores in this scale?
EVIDENCE ACQUISITION: The PubMed, Embase and CINAHL databases were searched from 1987 to February 2015. Two reviewers independently selected empirical studies published in English or in Spanish that applied the Modified Ashworth Scale and reported any reliability coefficient with the data at hand in children, adolescents or adults with spasticity.
EVIDENCE SYNTHESIS: Thirty-three studies reported any reliability estimate of Modified Ashworth Scale scores (N=1,065 participants). For lower extremities and inter-rater agreement, the mean intraclass correlation was ICC+ = 0.686 (95% CI: 0.563 and 0.780) and for kappa coefficients, k+ = 0.360 (95% CI: 0.241 and 0.468); for intra-rater agreement: ICC+ = 0.644 (95% CI: 0.543 and 0.726) and k+ = 0.488 (95% CI: 0.370 and 0.591). For upper extremities and inter-rater agreement: ICC+ = 0.781 (95% CI: 0.679 and 0.853) and k+ = 0.625 (95% CI: 0.350 and 0.801); for intra-rater agreement: ICC+ = 0.748 (95% CI: 0.671 and 0.809) and k+ = 0.593 (95% CI: 0.467 and 0.696). The type of design, the study focus, and the number of raters presented statistically significant relationships with ICC both for lower and upper extremities.
CONCLUSIONS: Inter- and intra-rater agreement for Modified Ashworth Scale scores was satisfactory. Modified Ashworth Scale’ scores exhibited better reliability when measuring upper extremities than lower. Several characteristics of the studies were statistically associated to inter-rater reliability of the scores for lower and upper extremities.


KEY WORDS: Reliability - Meta-analysis - Modified ashworth scale

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Publication History

Article first published online: September 13, 2017
Manuscript accepted: September 12, 2017
Manuscript revised: August 28, 2017
Manuscript received: April 28, 2017

Cite this article as

Meseguer-Henarejos AB, Sánchez-Meca J, López-Pina JA, Carles-Hernández R. Inter- and intra-rater reliability of the Modified Ashworth Scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2017 Sep 13. DOI: 10.23736/S1973-9087.17.04796-7

Corresponding author e-mail

anabelen@um.es