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Intra-rater reliability of the Modified Tardieu Scale in patients with multiple sclerosis
Soofia Naghdi1, Noureddin Nakhostin Ansari2, Sedighe Ghorbani-Rad1
1Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran.
Abstract:
The reliability of the Modified Tardieu Scale (MTS) has not been examined in patients with multiple sclerosis (MS). This study aimed to assess intra-rater reliability of the MTS in the assessment of lower limb spasticity in patients with MS. Data from 30 patients with MS (18 women, mean age = 41.5) were used to assess intra-rater reliability. An inexperienced physiotherapist in the scale randomly examined the hip adductors, knee extensors, and ankle plantar flexors on each subject twice with at least a 7-day interval. Kappa statistics (κ) were calculated for MTS quality of muscle reactions. Intraclass correlation coefficients (ICCagreement) and smallest detectable change (SDC) were calculated for R2, R1, and R2-R1. Qualitative rating of spasticity demonstrated moderate or good agreement, with an overall moderate κ of 0.72. Intra-rater reliability for all angle components of MTS was poor to good (ICCagreement range 0.45-0.83). The SDC for all the MTS components across the muscle groups was unacceptably large (range 14.6-55.6). Results did not establish good intra-rater reliability for the MTS when assessing lower limb muscle spasticity in patients with MS by a physiotherapist with no previous experience in the scale and with limited training.
Insights
The Modified Tardieu Scale (MTS) shows moderate reliability for assessing spasticity in multiple sclerosis (MS) lower limbs. However, its angle measurements have poor to good reliability and large detectable changes, questioning its clinical utility.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Biomechanics
Background:
- Spasticity is a common challenge in multiple sclerosis (MS), impacting mobility and quality of life.
- The Modified Tardieu Scale (MTS) is used to quantify spasticity, but its reliability in MS populations is underexplored.
- Accurate spasticity assessment is crucial for effective treatment planning and monitoring in MS.
Purpose of the Study:
- To evaluate the intra-rater reliability of the Modified Tardieu Scale (MTS) for assessing lower limb spasticity in patients with MS.
- To determine the consistency of MTS measurements when performed by a single, inexperienced clinician.
- To analyze both qualitative and quantitative aspects of MTS reliability in this specific patient group.
Main Methods:
- A cohort of 30 patients with MS underwent repeated lower limb spasticity assessments using the MTS by an inexperienced physiotherapist.
- Assessments of hip adductors, knee extensors, and ankle plantar flexors were conducted twice with a minimum 7-day interval.
- Intra-rater reliability was analyzed using Kappa statistics (κ) for qualitative reactions and Intraclass Correlation Coefficients (ICCagreement) for angle measurements (R2, R1, R2-R1). Smallest Detectable Change (SDC) was also calculated.
Main Results:
- Qualitative spasticity ratings showed moderate to good agreement (κ = 0.72).
- Quantitative angle measurements (ICCagreement) exhibited poor to good reliability, ranging from 0.45 to 0.83.
- The Smallest Detectable Change (SDC) values were unacceptably large (14.6–55.6), indicating significant measurement variability.
Conclusions:
- The Modified Tardieu Scale demonstrates moderate intra-rater reliability for qualitative spasticity assessment in MS lower limbs.
- Quantitative angle measurements and the overall precision of the MTS are questionable due to poor reliability and large SDCs in this inexperienced rater group.
- Further research with experienced clinicians and refined protocols is needed to establish the MTS's clinical utility for MS spasticity.
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