Tardieu Scale for spasticity


Intra-rater reliability of the Modified Tardieu Scale in patients with multiple sclerosis.

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.

Tardieu is a scale for measuring spasticity that takes into account resistance to passive movement at both slow and fast speed. The scale originally began development in the 1950s and has gone through multiple revisions. The most recent versions of the scale use the following criteria:

Individuals are positioned in sitting to test the Upper limbs = arms and Laying down to test the Lower limbs=legs

2 Measurements:
Quality of muscle reaction
Angle of muscle reaction
3 Speed definitions:
V1 is slow as possible
V2 speed of limb falling under gravity
V3 moving as fast as possible

Quality of Muscle Reaction (scored 0-5); 0 is no resistance to passive movement of the range of movement to 5 indicating joint is immobile.
(Some versions scored 0-4)

Joint Angle: Modified Tardieu describes R1 and R2; 
R1 is the angle of muscle reaction, R2 is the full range of movement (ROM). The angle of full ROM (R2) is taken at a very slow speed (V1). The angle of muscle reaction (R1) is defined as the angle in which a catch or clonus is found during a quick stretch (V3). R1 is then subtracted from R2 and this represents the dynamic tone component of the muscle. 

The Tardieu scale is part of the Canbex trial. 

In this study looked at the rater variability and found it to be variable when an in-experienced person repeatedly did the test . 

Therefore get experienced people to do the assessment, surely it is obvious that *h*t-in and you get s*i*-out

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  • This reminds me of when an unsupervised physiotherapist student was doing the arm extend behind head test on me. She did it completely wrong and as her supervisor wasn't there it was recorded as I was unable to do it. Junk in junk out.

  • Another voice added to the choir singing the most infuriating refrain in the corpus of published MS research: “The mechanisms/CNS pathways/pathophysiology/disease processes of spasticity in MS are poorly understood.”

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