COSMIN database

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

Hsieh, J. T., Wolfe, D. L., Miller, W. C., Curt, A., and Team, Scire Research
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.
Spinal Cord
1362-4393 (Print)
Publication year:
Functional status:
Physical functioning
Adults (18-65)
Children (0-18)
Seniors (65+)
Injury, poisoning and certain other consequences of external causes
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
AS - Ashworth scale
MAS - Modified Ashworth Scale   
PSFS - Penn Spasm Frequency Scale
SCATS - Spinal Cord Assessment Tool for Spastic reflexes
VAS - Visual Analogue Scale (versions: vertical; horizontal)   
WPT - Wartenberg Pendulum Test