Age and Ageing, Vol 29, 229-233, Copyright © 2000 by British Geriatrics Society
V Pomeroy, D Dean, L Sykes, E Faragher, M Yates, P Tyrrell, S Moss and R Tallis
Background. The central tenet of the neurofacilitatory
approach to stroke therapy is that muscle tone needs to be normal before
normal movement can occur. A reliable clinical measure of the full spectrum
of muscle tone is needed to test: (i) the purported relationship between
muscle tone, other motor impairments and disability, and (ii) the
effectiveness of stroke therapy to restore movement.Aim.
The purpose of the study was to test the inter-rater reliability
of clinical categorization of muscle tone (spastic/normal/flaccid) and also
a visual analogue scale with anchor points of 'lowest tone possible' (score
0) and 'highest tone possible' (score 100).Method.
Four independent raters assessed tone of elbow flexors and knee
extensors of 14 stroke rehabilitation inpatients using the categorical
scale. Six independent raters assessed tone of elbow flexors and knee
extensors of 25 chronic stroke patients and two healthy volunteers using
the visual analogue scale. All assessment orders were
randomized.Results. Both scales were unreliable, with
k coefficients for the categorical scale ranging from
-0.046 to 0.56 for the categorical scale, and intra-class correlation
coefficients for the visual analogue scale of 0.595 for elbow flexors and
0.451 for knee extensors. Assessment order effects for the visual analogue
scale were non-significant elbow flexors (P
ARTICLES
The unreliability of clinical measures of muscle tone: implications for stroke therapy
The Stroke Association's Therapy Research Unit, Department of Geriatric Medicine, Clinical Sciences Building, Hope Hospital, Eccles Old Road, Salford, Manchester M6 8HD, UK; Medical Statistics Support Unit, University of Manchester, Manchester, UK; Department of Geriatric Medicine, University of Manchester, Manchester Royal Infirmary, Manchester, UK; Rehabilitation Department, Hope Hospital, Salford, Manchester, UK; Corresponding author; Fax: 0161 787 5578; E-mail: Vpomeroy@fsl.ho.man.ac.uk
0.545) and
knee extensors (P0.911).Conclusion.
These results, and those of earlier studies, suggest that
clinical measures of muscle tone are consistently unreliable. Systematic
investigation of the therapy rationale for planning and evaluating
treatment is required before relevant clinical measures can be
developed.Keywords: muscle tone, physical therapy,
rehabilitation, reliability, stroke
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