Assessing lower limb spasticity – translating research findings into practice

Dr Ettie Ben-shabat1, Ms  Natalie  Fini1, Ms Catherine  Brooks1, Dr Mithu Palit1

1Alfred Health – Caulfield Hospital, Caulfield, Australia

Aim: To evaluate the intra and inter – rater reliability of the Modified Tardieu Scale (MTS) for assessing lower limb spasticity, and to translate the findings into clinician practice.

Methods: Thirty adults with lower limb spasticity were recruited from a outpatient neuro-rehabilitaion unit.  Two experienced physiotherapists performed slow (R2) and fast (R1) passive movements for lower limb muscles half an hour apart on the same day (interrater reliability).  One physiotherapist repeated the assessment 1 to 3 days earlier or later (intrarater reliability). Assessors also qualitatively rated the resistance to fast passive movements.

Results:  Intra- and interrater R1 and R2 measurements showed moderate to high reliability for the affected hamstrings, rectus femoris, gastrocnemius, soleus (mean Intraclass Correlation Coefficients 0.79±0.08), and tibialis anterior (mean Kappa coefficients (k) 0.58±0.10). Only intrarater measurements of the affected, tibialis posterior were moderately reliable (k, R1=0.57, R2=0.77). Qualitative spasticity ratings were moderately reliable for the affected hamstrings, gastrocnemius, and tibialis muscles (mean k, 0.52±0.10).

Significance of the findings to allied health:  The MTS is reliable for assessing spasticity in most of the lower limb muscles. Repeated measurements are best based on R1 measurements rather than spasticity angle or qualitative ratings of spasticity. Optimally, MTS measurements should be undertaken by the same clinician.  In 2016 we rant a workshop aimed at translating these findings into practice (“How to assess hypertonicity in the lower limb? An interactive workshop”).  Pre and post workshop questionnaires showed that the workshop addressed clinicians’ need to improve their skill in assessing hypertonicity.