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Updated: Jan 12, 2026
Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity
Published on: June 12, 2019
Early identification for spasticity patient referral needs: an inter-rater reliability study of the post-stroke
Jorg Wissel1, Atul Patel2, Ganesh Bavikatte3
1Neurology and Psychosomatic at Wittenbergplatz, Outpatient Clinic, Berlin, Germany.
Background:
The post-stroke spasticity (PSS) Referral Tool was developed to assist health care professionals in the early identification of patient referral needs. An inter-rater reliability (IRR) study using videos of patients with different stages of or without predictors of PSS was performed to validate its utility in clinical practice.
Research Design And Methods:
This prospective study had 3 parts: patient video production (Part A); expert panel classification of patient videos into PSS Referral Tool categories (Part B; Urgent Referral [UR; red], Routine Referral [RR; yellow], Periodic Monitoring [PM; green]), and an IRR analysis from global clinician raters (Part C). IRR was estimated using the intra-class correlation coefficient (ICC) with a 2-way random effect, absolute agreement, single-measurement model ( < 0.50 [poor]; 0.50-0.75 [moderate]; 0.76-0.90 [good]; > 0.90 [excellent]).
Results:
In total, 50 raters participated and 70% had no prior experience using the PSS Referral Tool. IRR (ICC [95% CI]) was moderate (0.68 [0.53, 0.84]) and most video ratings were correct (UR/RR: 69.2% [173/250]; PM: 88.0% [220/250]). Sensitivity was highest in raters with no or moderate experience (93.3% [14/15]).
Conclusions:
Irrespective of previous experience and geographic region of practice, the PSS Referral Tool accurately identified patients at risk for PSS.
