# Reliability of the Five Step Assessment and Its Coefficients of Impairment in Spastic Paresis

## TL;DR

The Five Step Assessment is a reliable tool for measuring muscle impairments in chronic spastic paresis, with most parameters showing strong consistency across raters.

## Contribution

The study establishes the reliability of the Five Step Assessment's parameters and coefficients in evaluating chronic spastic paresis.

## Key findings

- The five parameters of the Five Step Assessment show good-to-excellent intrarater and interrater reliability.
- Four coefficients of impairment have moderate-to-excellent reliability, except for spasticity grade Y and fatigability.
- The assessment takes about two minutes per muscle and is feasible in clinical settings.

## Abstract

•The Five Step Assessment yields five parameters and four coefficients of impairment.•The scale estimates the degree of muscle shortening, spasticity, weakness, and fatigability.•The five parameters have good-to-excellent intrarater and interrater reliabilities.•The four coefficients have moderate-to-excellent intrarater and interrater reliabilities.•The Five Step Assessment takes a little over two minutes per muscle.

The Five Step Assessment yields five parameters and four coefficients of impairment.

The scale estimates the degree of muscle shortening, spasticity, weakness, and fatigability.

The five parameters have good-to-excellent intrarater and interrater reliabilities.

The four coefficients have moderate-to-excellent intrarater and interrater reliabilities.

The Five Step Assessment takes a little over two minutes per muscle.

To determine the intrarater and interrater reliability of the Five Step Assessment (FSA) and its derived coefficients of impairment in chronic spastic paresis.

Prospective observational study.

Study of outpatients followed in a rehabilitation department.

In this single-center prospective study, participants (n=18) with chronic hemiparesis (>1y since injury) were evaluated by 4 raters (3 medical doctors, 1 physiotherapist; experience in hemiparesis, 14±9y).

All raters estimated muscle shortening, spasticity, weakness, and fatigability against the resistance of 8 key antagonists in adults twice, one week apart.

FSA involves measuring 4 angles: angle of arrest at slow speed of stretch (XV1), angle of catch or clonus at fast speed of stretch (XV3, Tardieu), angle of match between maximal agonist effort and passive and active antagonist resistances (XA), residual angle of match after 15 seconds of repeated maximal amplitude active efforts (XA15), and spasticity grade Y. Four derived coefficients of impairment were studied: coefficients of shortening, CSH=(XN−XV1)/XN (XN, normally expected maximal passive joint amplitude); of spasticity, CSP=(XV1−XV3)/XV1; of weakness, CW=(XV1−XA)/XV1; and of fatigability, CF=(XA−XA15)/XA. Both intraclass correlation coefficients and mean differences were calculated for each parameter.

Among 18 participants (four women), intrarater reliability was good to excellent (intraclass correlation coefficient >0.75) for all parameters in all muscles. Interrater reliability was good to excellent for all muscles and parameters except for spasticity grade Y and coefficient of fatigability (moderate).

The 5 parameters and 4 coefficients of impairment of the FSA have moderate-to-excellent intrarater and interrater reliability in chronic spastic paresis.

Image, graphical abstract