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Inter- and intra-rater variability of testing velocity when assessing lower limb spasticity

journal contribution
posted on 2021-01-12, 00:42 authored by Megan Banky, Ross A Clark, Yong-Hao Pua, Benjamin MentiplayBenjamin Mentiplay, John H Olver, Gavin Williams
© 2019 Foundation of Rehabilitation Information. 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.


This project was supported by funding obtained from the Australian Physiotherapy Research Foundation Seeding Grant, Royal Automobile Club of Victoria Sir Edmund Herring Memorial Scholarship, and the Epworth Research Institute.


Publication Date



Journal of Rehabilitation Medicine






7p. (p. 54-60)


Foundation for Rehabilitation Information



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