Reliability of the Modified Ashworth Scale in post-stroke spasticity assessment: cross-sectional study

Abstract

Introduction. Spasticity evaluation in stroke survivors is crucial for effective rehabilitation. The Modified Ashworth Scale (MAS) is commonly used for this purpose, but its reliability when administered by less expe-rienced individuals like physiotherapy students remains understudied. Therefore, our objective is to assess the inter-observer reliability of the MAS among physiotherapy students for evaluating post-stroke lower limb spasticity. Methods. Thirty-two patients (24 males, 65.2 ± 13.9 years) with hemiplegia/hemiparesis at least six months post-stroke were enrolled. Extensors and flexors in the hip, knee, and ankle of each participant were assessed independently by two trained final-year physiotherapy students, approximately 5 min apart. The Weighted Cohen’s Kappa Index (K) was calculated. Results. The MAS showed substantial agreement for hip extensors (K = 0.78) and flexors (K = 0.70), knee flexors (K = 0.77), dorsiflexors (K = 0.64), and plantar flexors (K = 0.63), and fair agreement for knee extensors (K = 0.54). Conclusions. Novice physiotherapy students demonstrated reliable application of the MAS when evaluating spasticity in the lower limbs of individuals recovering from strokes. Substantial agreement in most muscle groups examined supports the use of the MAS as a valid tool for assessment, even during the initial phases of clinical education.