Validity and reliability of the Modified Tardieu Scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis

PurposeTo evaluate published evidence on the Modified Tardieu Scale (MTS) as a tool to assess spasticity in the upper limbs of adults with neurological conditions.Data sourcesA systematic search of six electronic databases (PubMed/MEDLINE, CINAHL, EMBASE, the Cochrane Library, Web of Science and Physiotherapy Evidence Database) from inception to 31 December 2020. A search strategy was developed using key elements of the research question: population, intervention (action), outcome.Study eligibility criteriaInclusion criteria: (1) adult participants with neurological conditions; (2) upper limb muscles/joints as tested elements; (3) studies testing the MTS and (4) reliability or validity reported. Exclusion criteria: (1) non-English articles; (2) non-empirical articles and (3) studies testing the Tardieu Scale.Study appraisalEvidence quality was evaluated using the US National Heart, Lung, Blood Institute quality assessment tool for observational cohort and cross-sectional studies.ResultsSix reliability studies met the inclusion criteria. Overall, most articles reported good-to-excellent levels of inter-rater, intrarater and test–retest reliability. However, limitations, such as study design weaknesses, statistical misuses and reporting biases, undermine confidence in reported conclusions. The validity of the MTS also remained questionable based on the results of one study.Conclusions and implicationsThis review did not find sufficient evidence to either support or reject the use of the MTS in assessing spasticity in the upper limbs of adults with neurological conditions. Despite the paucity of research evidence, the MTS may still remain a clinically useful tool to measure the motor aspect of spasticity. Future research would benefit from a focus on test standardisation, while the wider field would require the development of a consensual definition of spasticity.

Electrophysiological Evaluation of the Modified Ashworth Scale in Assessment of Post Stroke Ankle Plantar Spasticity

Background: Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measure of muscle spasticity, using validated tools to evaluate the outcome of therapies is important in clinical and research settings. Objective: To determine the concurrent criterion-related validity of the Modified Ashworth Scale in assessing post stroke Ankle flexor muscle spasticity based on its correlation with Modified Tardieu scale and the H-reflex tests. Methods: A total of 35 adult stroke participants underwent clinical and electrophysiological assessment of the ankle flexor muscle spasticity on the affected side. The primary outcome measures were: MMAS grade, R2−R1 of the MTS; and the H-reflex indices of H-max/M-max ratio. Results: Correlations tests revealed the correlation between the MMAS and MTS but did not reveal significant associations between the MMAS and the H-reflex tests. Conclusions: This study suggests that the MMAS may not be a valid tool to evaluate the ankle flexor muscle spasticity in these stroke participants. Key words: Stroke, spasticity, Modified Ashworth Scale, Tardieu Scale, H-reflex, criterion validity.

Translation and cross-cultural adaptation to Brazilian Portuguese of the Modified Tardieu Scale for muscle tone assessment among patients with spinal cord injury

ABSTRACT Background: Assessment of muscle tone is of great importance for evaluating people with spinal injuries. Objective: To translate and adapt the Modified Tardieu Scale (MTS) to Brazilian Portuguese and validate its use for evaluating patients with spinal cord injury. Methods: The translation and adaptation of the “Escala de Tardieu Modificada” went through the steps of translation, translation synthesis, back-translation and expert committee meeting. Two evaluators rated the tone of the elbow flexors/extensors, wrist extensors, knee flexors/extensors and ankle plantar flexors of 51 patients with spinal cord injury. These patients were reevaluated after one week. Validation included intra and inter-rater reliability (ICC) and internal and external consistency. The Modified Ashworth Scale (MAS) was used in the evaluations, to investigate the correlations. Results: The Brazilian Portuguese version of the MTS is presented in this study. ICCs ranged from 0.60 to 0.99 (intra and inter-examiner) and there was a moderate to strong correlation with MAS. Conclusions: The MTS proved to be adequate for assessing the muscle tone of people with spinal cord injury in Brazil.