Novita Research Report January 1999 - Novita Children's Services

Intra-rater and inter-rater reliability of the Tardieu Scale to quantify spasticity
in biceps brachii in children with cerebral palsy.
Marianne Spizzo 1
Honours student
Supervisors
Andrea
Warden Flood 1
Senior Lecturer
Paula Harris 2
Chief Physiotherapist
Novita Supervisor
Susan Gibson
Senior Research
Physiotherapist
1
School of Health Sciences
– Physiotherapy, University
of South Australia
2
Lyell McEwin Hospital,
Adelaide, South Australia
Objective
The Tardieu scale is a commonly used test of spasticity that involves determining the difference between full
passive range of motion at slow speed and then the angle of catch at fast speed in single joints such as the elbow.
The aim of this study was to establish both intra-rater and inter-rater reliability of the Tardieu scale in biceps brachii
of children with cerebral palsy.
Method
In this randomised single-blind design study, five participants with cerebral palsy (aged 4 – 16 years) were
randomly assigned to one of two groups. Both right and left arms were tested on one subject, resulting in a sample
of six limbs. Each subject was tested in supine on two consecutive days and at the same time of day. On each day,
the Tardieu scale was assessed twice with a 5-minute inter-test interval during which the participant moved into
sitting and was repositioned in supine prior to the second test. On day 1, one Rater (A) performed both tests. On
day 2, Rater A was followed by Rater B for Group 1, and Rater B was followed by Rater A for Group 2. To blind the
raters, an independent investigator measured all angles with a goniometer and recorded the results.
Results
Intra-rater reliability was acceptable (ICC(1,1) = 0.80) whereas inter-rater reliability was low (ICC(1,1) = 0.51)
suggesting that the Tardieu score is not reproducible between the raters and that one rater may be required to
conduct all tests to ensure agreement between repeated measures. These findings were supported by standard
errors of measurement (intra-rater SEM = 6.65º and inter-rater SEM = 12.28º). Further, the minimal detectable
change needed to demonstrate treatment effectiveness was 19º for one therapist and 35º for two therapists when
using the Tardieu score as the outcome measure.
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Implications
The findings of this study suggest that the use of the Tardieu scale is justified when used by only one therapist for
the measurement of biceps brachii spasticity in a child with cerebral palsy. If different therapists use the Tardieu
scale, a change in score may be due to a difference in measurement technique and not a treatment effect. Further
studies are needed to determine the intra- and inter- rater reliability of this scale with a larger sample and in other
muscle groups and starting positions.
Project completed in 2001
Novita Children’s Services Incorporated • Research Report January 1999 – June 2004