Inter-rater reliability of the modified modified ashworth scale as a clinical tool in measurements of post-stroke elbow flexor spasticity

Noureddin Nakhostin Ansari, Soofia Naghdi, Scott Hasson, Atefeh Mousakhani, Azam Nouriyan, Zeinab Omidvar

Research output: Contribution to journalArticle

21 Scopus citations


Patients with neurological conditions may be affected by spasticity. The Modified Modified Ashworth Scale (MMAS) is a clinical tool used to measure spasticity. The purpose of the present study was to investigate the inter-rater reliability of the MMAS during the assessment of elbow flexor spasticity in adult patients with post-stroke hemiplegia. Twenty-one adult patients with stroke (5 women, 16 men) with a median age of 60 years (interquartile range, 47-68) were tested. Elbow flexors on the affected side were examined. Inter-rater reliability for two inexperienced raters was very good. The weighted Kappa value was 0.81 (Standard Error = 0.097, 95% CI: 0.62-1.00, p = 0.0002). The weighted percentage agreement was 97.4%. The agreement between raters occurred mostly on score 1 (38.1%) followed by score 0 (23.8%). The MMAS yielded reliable measurements between raters when used on patients post-stroke with elbow flexor spasticity.

Original languageEnglish (US)
Pages (from-to)225-229
Number of pages5
Issue number3
Publication statusPublished - Jul 31 2009



  • Inter-rater reliability
  • Modified modified ashworth scale
  • Spasticity
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology

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