Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study
Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study
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DOI：
10.1191/0269215505cr889oa
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发表时间：
2005-10-01
影响因子：
3
通讯作者：
Pohl, M
中科院分区：
文献类型：
--
作者：
Mehrholz, J;Wagner, K;Pohl, M
目的：评价和比较改良Tardieu量表与改良Ashworth量表在重型颅脑损伤合并意识障碍患者中的可靠性。设计：横断面观察性比较研究。环境：成人神经系统疾病早期康复中心。研究对象：30例不同原因的重度脑损伤患者。测量方案：四名经验丰富的物理治疗师按随机顺序对每位患者进行评分，每天一次，连续两天。采用改良Tardieu量表和改良Ashworth量表数据收集程序评估肩、肘、腕、髋、膝和踝关节痉挛。主要结果测量：修正Tardieu量表和修正Ashworth量表的重测和量表间信度（kappa = kappa值）。结果：改良Ashworth量表的重测信度为中至良好（kappa = 0.47 ~ 0.62），改良Tardieu量表的重测信度为中至极好（kappa = 0.52 ~ 0.87）。除肩伸肌和内旋肌外，改良Tardieu量表的重测信度显著高于改良Ashworth量表（Z > 1.96, p < 0.05）。虽然两种量表的量表间信度均为差至中等（修正Ashworth量表：kappa = 0.16-0.42；修正Tardieu量表：kappa = 0.29-0.53），但除腕伸肌外，修正Tardieu量表的k值均显著高于其他肌群（Z >.96; p < 0.05）。结论：在重度脑损伤和意识受损患者中，改良Tardieu量表比改良Ashworth量表具有更高的重测信度和量表间信度，因此可能是一种更有效的成人痉挛量表。
Objective: To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness.Design: Cross-sectional observational comparison study.Setting: An early rehabilitation centre for adults with neurological disorders.Subjects: Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies.Measurement protocol: Four experienced physical therapists rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, hip, knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures.Main outcome measures: Test-retest and inter-rater reliability (kappa = kappa value) of the Modified Tardieu Scale and the Modified Ashworth Scale.Results: The test-retest reliability of the Modified Ashworth Scale was moderate to good (kappa = 0.47-0.62) and of the Modified Tardieu Scale moderate to very good (kappa = 0.52-0.87). Test-retest reliability was significantly higher within the Modified Tardieu Scale in comparison with the Modified Ashworth Scale (Z > 1.96; p < 0.05) except for shoulder extensor and internal rotator muscles (Z< 1.96; p > 0.05). Although inter-rater reliability of both scales was poor to moderate (Modified Ashworth Scale: kappa = 0.16-0.42; Modified Tardieu Scale: kappa = 0.29-0.53), significantly higher K-values were revealed with the Modified Tardieu Scale for all tested muscle groups (Z > 1,96; p < 0.05) except for wrist extensors (Z< 1.96; p > 0.05).Conclusion: In patients with severe brain injury and impaired consciousness the Modified Tardieu Scale provides higher test-retest and inter-rater reliability compared with the Modified Ashworth Scale and may therefore be a more valid spasticity scale in adults.