Kritische Einschätzung der Modifizierten Ashworth-Skala, ihrer Gütekriterien und ihre Anwendung in der klinischen Praxis

Zusammenfassung

Die Modifizierte Ashworth-Skala (MAS) ist der Goldstandard aller Assessments für Outcome-Messungen bezüglich Tonus bzw. Spastizität. Die vorliegende Arbeit sichtet Studien, die auf die psychometrischen Eigenschaften dieses Assessments eingehen, und beurteilt die klinische Entscheidungsfindung zu dessen Anwendung. Die betrachteten Publikationen kommen zu inkonsistenten Ergebnissen. Es gibt keine standardisierte Methode einer angemessenen Anwendung der MAS, und die ausschlaggebenden Gütekriterien Validität und Reliabilität sind für die MAS umstritten. Ihre Validität wird durch Unklarheiten hinsichtlich der Begriffe Spastizität und Tonus in Frage gestellt. Ihre Reliabilität erweist sich bei von nur einem Untersucher durchgeführten Tests der Ellenbogenflexoren als am besten. In anderen Fällen ist die Reliabilität nicht immer gegeben. Über die Anwendung der MAS ist jeweils umsichtig und fallspezifisch zu entscheiden.

Abstract

The Modified Ashworth Scale (MAS) is the gold standard outcome measure for tone and spasticity. This paper reviewed studies looking at the measure’s psychometric properties and appraised clinical decisions about its application. The literature revealed inconsistent findings. The MAS lacks standardisation in terms of appropriate application, and its validity and reliability remain controversial. Validity is challenged by semantic confusion about the terms spasticity and tone. Reliability shows best results when testing elbow flexors and using one examiner. In other situations reliability it not always given. Decisions about application of the MAS should be made judiciously and from case to case.

Schlüsselwörter

Assessment - Modifizierte Ashworth-Skala - Gütekriterien - Spastizität

Key words

Outcome measures - Modified Ashworth Scale - psychometric properties - spasticity

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