學院 |
醫學院 |
系所 |
職能治療學系 |
題名 |
Responsiveness and minimal clinically
important difference of Modified Ashworth Scale in patients with stroke. |
作者 |
Chen, C-L*†, Chen, C-Y†, Chen, H-C, Wu, C-Y, Lin, K-C, Hsieh, Y-W, Shen, I-H |
期刊名稱 |
European
Journal of Physical and Rehabilitation Medicine. (SCIE-Indexed) |
發表日期 |
2019 |
著作性質 |
原著 |
語文 |
英文 |
關鍵字 |
stroke, muscle spasticity, minimal clinically important
difference, psychometrics |
摘要 |
BACKGROUND: Spasticity is a major problem in patients with stroke and influences
their activities of daily living, participation, and quality of life. The
Modified Ashworth Scale is widely used to assess spasticity. However, the
responsiveness and minimal clinically important differences of the Modified
Ashworth Scale in patients with stroke have not been explored. AIM: This study aims to examine the responsiveness and minimal
clinically important differences of the Modified Ashworth Scale in patients
with stroke. DESIGN: Longitudinal six-month follow-up study. SETTING: Rehabilitation wards of a tertiary hospital. POPULATION: One-hundred and fifteen patients with stroke were
recruited. METHODS: All patients underwent the assessment of Modified Ashworth
Scale for the upper extremity (flexors of the elbow, wrist, and fingers) and
the lower extremity (hip adductor, knee flexor, and ankle plantar flexor) at
baseline and 6-month follow-up. The average Modified Ashworth Scale scores of
the upper and lower extremity muscles were obtained for analysis.
Responsiveness of the Modified Ashworth Scale was determined using
standardized mean response, and the minimal clinically important differences
were determined using a distribution-based approach with Effect Sizes of 0.5
and 0.8 standard deviations. RESULTS: The responsiveness of the Modified Ashworth Scale in the
upper and lower extremity muscles was marked (standardized response mean =
0.89-1.09). The minimal clinically important differences of the average
Modified Ashworth Scale of Effect Sizes 0.5 and 0.8 standard deviations for
the upper extremity muscles were 0.48 and 0.76, respectively, while those for
the lower extremity muscles were 0.45 and 0.73, respectively. CONCLUSIONS: The Modified Ashworth Scale was markedly responsive in
detecting the changes in muscle tone in patients with stroke. The minimal
clinically important differences of the Modified Ashworth Scale reported in
this study can be used by researchers and clinicians in determining whether
the observed changes are clinically meaningful post-treatment or at
follow-up. CLINICAL REHABILITATION IMPACT: The minimal clinically important
differences of the Modified Ashworth Scale reported in this study will enable
clinicians and researchers in determining whether changes in the muscle tone
are true and clinically meaningful, and can be used as a reference for
clinical decision-making. |