Development of the Persian version of the Modified Modified Ashworth Scale: translation, adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity

Abstract

Purpose: Development of the Persian version of the Modified Modified Ashworth Scale (MMAS), and to investigate the interrater and intrarater reliability of the Persian MMAS when used to quantify elbow flexor spasticity in patients after stroke. Methods: The Persian MMAS was developed by the forward and backward translation procedure, a final review by an expert committee, and testing for acceptability and the clarity of item wording so that the scale could be used by Persian-speaking examiners. Psychometric testing included interrater and intrarater reliability. Elbow flexor spasticity was examined by two raters in 30 patients after stroke twice on two occasions using the Persian MMAS. The weighted κ was used for the statistical analysis. Results: The interrater and intrarater reliability was very good for the Persian MMAS (weighted κ: 0.81–0.91; 95% CI 0.68–0.98) with statistically significant agreement between raters and within raters (all p < 0.001). Conclusions: The Persian version of the MMAS was successfully developed. The Persian MMAS showed very good interrater and intrarater reliability in patients with elbow flexor spasticity after stroke. The results support the use of the Persian version of the MMAS both in clinical and research settings.

Implications for Rehabilitation

• The new Modified Modified Ashworth Scale (MMAS) is a clinical measure of spasticity, which was published in 2006 by Ansari et al.

• The MMAS was successfully translated and adapted into a Persian version. The Persian version of the MMAS showed very good interrater and intrarater reliability comparable to the original English version. The Persian version of the MMAS can be recommended for the assessment of muscle spasticity in Persian-speaking countries.

Keywords::

• Modified Modified Ashworth Scale
• Persian language
• reliability
• spasticity
• stroke

Acknowledgements

We would like to thank the patients, the clinicians and the staff from the Tabassom Center of Stroke Rehabilitation for supporting this study.

Declaration of Interest: The authors report no conflicts of interest.