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Title: Inter- and intra-rater variability of testing velocity when assessing lower limb spasticity.
Epworth Authors: Banky, Megan
Olver, John
Williams, Gavin
Other Authors: Clark, Ross
Mentiplay, Benjamin
Pua, Yong-Hao
Keywords: Lower-Limb Spasticity
Fast Testing Velocity
Joint Range of Motion and Position Assessment
Paraparesis, Spastic
Neurologic Manifestations
Observational Study
Spasticity Assessment
Upper Motor Neurone Lesion
Motor Neurons
Lower Extremity
The Modified Tardieu Scale
Mean Absolute Differences
Quadriceps Muscle
Hamstring Muscles
Hamstring Tendons
Gastrocnemius Muscle
Soleus Muscle
Muscle, Skeletal
Lower Limb Assessors
Knee Joint
Ankle Joint
Quadriceps Muscle
Central Nervous System Diseases
Reproducibility of Results
Muscle Spasticity
Patient Outcome Assessment
Issue Date: 2019
Publisher: Foundation of Rehabilitation Information
Citation: J Rehabil Med, (2019), 51(00–00):pp.1-7
Abstract: Objective: To establish the variability of fast testing velocity and joint range of motion and position when assessing lower-limb spasticity in individuals following neurological injury. Design: Observational study of people with lower-limb spasticity. Subjects: Patients with an upper motor neurone lesion (n = 35) and clinicians experienced in spasticity assessment (n = 34) were included. Methods: The Modified Tardieu scale (MTS) was completed on the quadriceps, hamstrings (2 positions), gastrocnemius and soleus for each participant’s more affected lower limb by 3 assessors. Mean absolute differences (MADs) were used to calculate variability as a measure of reliability. Results: Variability of peak testing velocity was greater at the ankle joint compared with the knee joint. The greatest MAD for V3 (fast) inter-rater testing velocity was 119°/s in the soleus, representing 29.4% of the mean variable value, and least for the quadriceps (64.3°/s; 18.5%). Inter-rater variability was higher than intra-rater variability for all testing parameters. The MAD for joint end angle ranged from 2.6° to 10.7° and joint start angle from 1.2° to 14.4°. Conclusion: There was a large degree of inter- and intra-rater variability in V3 testing velocity when using the MTS to assess lower limb spasticity. The inter-rater variability was approximately double the intra-rater variability.
DOI: 10.2340/16501977-2496
PubMed URL:
ISSN: 1650-1977
Journal Title: Journal of Rehabilitation Medicine
Type: Journal Article
Affiliated Organisations: Department of Physiotherapy, Epworth HealthCare, Melbourne
School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
La Trobe Sport and Exercise Medicine Research Centre, La Trobe University
Victorian Infant Brain Studies, Murdoch Children’s Research Institute
Epworth Monash Rehabilitation Medicine Unit, Melbourne
Department of Physiotherapy, University of Melbourne, Melbourne, Australia
Type of Clinical Study or Trial: Observational Study
Appears in Collections:Rehabilitation

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