Scrambled Eggs: Misidentification of Ashworth Scales in Research and Clinical Practice.

TitleScrambled Eggs: Misidentification of Ashworth Scales in Research and Clinical Practice.
Publication TypeJournal Article
AuthorsBrown TR, Kraft GH, Gray T, Kuehn CM
JournalInternational Journal of MS Care

In 1964, Bryan Ashworth introduced the five-point Ashworth scale (AS) as a measure of tone and spasticity. Several modifications have since been introduced and all are referred to as Modified Ashworth Scale (MAS). The coexistence of multiple scales with similar or identical names prompted us to conduct a literature search and practitioner survey to determine current scale usage patterns and consistency. We did a MEDLINE search using the term Ashworth scale on December 22, 2003. We examined usage of the AS and MAS variations in the first 130 medical references (spanning 2003-1999). Excluded were review articles, non-English language texts, and studies that did not actually use the AS or MAS. For each article, we recorded the spasticity scale that was used and whether it was correctly identified, labeled and referenced. We did Chi-square testing to search for associations between scale misusage and the authors' geographic region and health field. We also conducted a web-based spasticity-scale usage survey amongst physiatrists in the Northwest. Of 130 articles, 105 met our inclusion criteria. Of these, 36 (34%) were found to contain errors of mislabeling, misidentification or misreferencing of the AS or MAS. Chi-square testing revealed no statistical associations between such errors and authors' geographic region or authors' health field. The results of the practitioner survey will be presented. Over one-third of all published research articles misidentify, mislabel or misreference the AS or MAS. There are several versions of the MAS, which may be confused with each other or with the AS. There is only one version of the AS. When employing the AS or MAS, the scale should be fully enumerated and referenced. It may be preferable to use the less ambiguous AS for clinical purposes.

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