Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility

• Published in: Spinal cord Vol. 46; no. 2; pp. 86 - 95
• Main Authors: Hsieh, J T C, Wolfe, D L, Miller, W C, Curt, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2008; Nature Publishing; Nature Publishing Group
• Subjects: Anatomy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Medical sciences; Muscle Spasticity - etiology; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; Outcome Assessment (Health Care) - methods; Psychometrics; review; Sensitivity and Specificity; Spinal Cord Injuries - complications; Traumas. Diseases due to physical agents; spinal cord injury; spasticity; validity; outcome measures; reliability; Nervous system diseases; Prognosis; Vertebral canal; Spasticity; Muscle tonus alteration; Psychometrics; Validity; Striated muscle disease; Spinal cord trauma; Central nervous system disease; Neurological disorder; Reliability; Spinal cord disease
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3102125

Study design: Comprehensive review and systematic analyses. Objectives: Assess published psychometric evidence for spinal cord injury (SCI) spasticity outcome measures. Considerations about the influence of spasticity on function have also been identified to understand treatment effects and guide service delivery. Setting: London, Ontario and Vancouver, British Columbia, Canada. Method: Review of measures was based on availability of psychometric data, application in clinical settings and evaluated in SCI patients. Results: Ashworth and Modified Ashworth Scales (AS, MAS), Penn Spasm Frequency Scale (PSFS), Spinal Cord Assessment Tool for Spasticity (SCATS), Visual Analogue Scale self-rated scale of spasticity (VAS) and the Wartenberg Pendulum Test (WPT) were included in this review. The most frequently used tools for SCI spasticity measurement include the AS, MAS, PSFS and VAS, of which the latter two are self-report spasticity measures. The SCATS has been partially validated for SCI, but is not widely used. The WPT has been minimally validated despite its use in a large-scale SCI spasticity randomized controlled trial. Conclusions: Since spasticity is multidimensional, focusing on one or two spasticity outcome measures can misrepresent the extent and influence of spasticity on SCI patients. Different scales measure different aspects of spasticity and individual tools correlate weakly with each other. Spasticity may be better measured with an appropriate battery of tests, including the AS or MAS, along with PSFS. These tools would benefit from further reliability and responsiveness testing. Tools that assess the influence of spasticity on patient activities, participation and quality of life are important, but lacking.