Intra- and interrater reliability of the Modified Ashworth Scale and its association with the Tardieu Scale in children with cerebral palsy

Mikša-Pušnik, Daša (author), Pirkmajer, Sergej (author), Tomc Žargi, Tina (author)

Background The Modified Ashworth Scale is a widely used tool for assessing spasticity. The aim of this study was to evaluate the intra- and interrater reliability of the Modified Ashworth Scale and its association with the Tardieu Scale in children with cerebral palsy. Methods In this cross-sectional study, 23 children with cerebral palsy were included. The intra- and interrater reliability of the Modified Ashworth Scale was assessed for the elbow, knee, and plantar flexors of the foot. The results of the Tardieu Scale were included to evaluate the association between the two scales. The intraclass correlation coefficient (ICC) was used to assess reliability, and Spearman’s correlation coefficient was used to assess the association between the Modified Ashworth Scale and the Tardieu Scale. All muscles assessed were included in the analysis, regardless of the anatomical classification of physical impairment. Results Intrarater reliability (ICC) in our sample was excellent for all muscles assessed (ICC = 0.91–0.99). Interrater reliability was generally good, with confidence intervals indicating moderate to good reliability in certain muscle groups (ICC = 0.80–0.89). A moderate positive correlation was observed between the Tardieu Scale and the Modified Ashworth Scale for all muscles assessed. Conclusions The results demonstrated excellent intrarater and generally good interrater reliability in a heterogeneous primary healthcare sample, with a moderate positive correlation between the scales studied. However, caution is warranted when interpreting findings at the individual level.

• Language: English
• Keywords: children, cerebral palsy, spasticity assessment, psychometric properties, modified Ashworth scale, Tardieu scale
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: ZF - Faculty of Health Sciences; MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Publication date: 01.01.2026
• Year: 2026
• Number of pages: 14 str.
• Numbering: Vol. 14, art. e21349
• PID: 20.500.12556/RUL-184192
• UDC: 616.831-053.2
• ISSN on article: 2167-8359
• DOI: 10.7717/peerj.21349
• COBISS.SI-ID: 283222019
• Publication date in RUL: 01.07.2026

Record is a part of a journal

• Title: PeerJ
• Shortened title: PeerJ
• Publisher: PeerJ Inc.
• ISSN: 2167-8359
• COBISS.SI-ID: 31891929

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P3-0043-2020
• Name: Molekularni mehanizmi razvoja in delovanja skeletne mišice

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: J7-60125-2025
• Name: Neživalski živčno-mišični model za preučevanje nevrogenega uravnavanja ionskega transporta in endokrine funkcije skeletne mišice in vitro (NeuroMyo)