Related Experiment Video
Updated: May 31, 2026
08:40
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 recognition of post-stroke spasticity: the I-REFER study
Klemens Fheodoroff1, Benjamin Waeschle2, Manuela Schuetzer3
1KABEG Gailtal-Klinik, Neurorehabilitation, Hermagor, Austria.
Frontiers in Neurology
|May 29, 2026
Summary
A new decision tree effectively helps nurses and therapists identify post-stroke spasticity (PSS). This tool improves early PSS recognition and referral, leading to timely diagnosis and treatment.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Assessment Tools
Background:
- Effective management of post-stroke spasticity (PSS) is hindered by limited access to specialists, leading to underdiagnosis and undertreatment.
- Empowering non-specialist healthcare professionals, such as nurses and therapists, to identify PSS can expedite appropriate referrals.
- This study evaluated the validity and inter-rater reliability of a novel decision tree for upper extremity PSS.
Purpose of the Study:
- To assess the validity and inter-rater reliability (IRR) of the spastic movement disorders decision tree for upper extremity spasticity.
- To compare referral decisions made by nurses and therapists using the decision tree against those made by specialist physicians.
Main Methods:
- A decision tree was used by nurses and therapists to evaluate three cardinal symptoms of PSS (elbow, wrist, fingers) as "no/minimal," "moderate," or "severe."
- Referral decisions (n=69) from five nurses and four therapists were compared to specialist physician assessments.
- Inter-rater reliability (IRR), sensitivity, specificity, and predictive values were calculated.
Main Results:
- High IRR was observed between nurses and physicians for specialist referral decisions (overall 85.5%).
- The decision tree demonstrated high sensitivity (84.6%) and specificity (86.7%) in identifying patients needing specialist referral.
- Similar high validity and reliability were found for therapists compared to physicians, with high positive (89.2%) and negative (81.3%) predictive values.
Conclusions:
- The spastic movement disorders decision tree is a valid and reliable tool for nurses and therapists to identify potential PSS in the upper extremities.
- This tool can facilitate early recognition and specialist referral, potentially improving timely diagnosis and treatment, including botulinum toxin type A (BoNT-A).
- Introduction into standard clinical practice and examination of broader community use are recommended.
