Reliability and Validity of the Modified Heckmatt Scale in Evaluating Muscle Changes With Ultrasound in Spasticity

Marisa C Moreta; Alana Fleet; Rajiv Reebye; Gina McKernan; Michael Berger; Jordan Farag; Michael C Munin

doi:10.1016/j.arrct.2020.100071

Reliability and Validity of the Modified Heckmatt Scale in Evaluating Muscle Changes With Ultrasound in Spasticity

Arch Rehabil Res Clin Transl. 2020 Jul 1;2(4):100071. doi: 10.1016/j.arrct.2020.100071. eCollection 2020 Dec.

Authors

Marisa C Moreta¹, Alana Fleet², Rajiv Reebye², Gina McKernan³, Michael Berger⁴, Jordan Farag², Michael C Munin^{1

3}

Affiliations

¹ Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
² Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁴ International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

Objectives: To determine the reliability and validity of the Modified Heckmatt scale in assessing muscle echotexture in spasticity.

Design: Prospective, observational, 2-center study. Two residents and 2 ultrasound experienced staff physicians each rated 100 ultrasound images that were also analyzed using quantitative gray-scale.

Setting: Academic ambulatory spasticity clinic.

Participants: Participants (N=50) included 45 patients with upper or lower extremity spasticity and 5 healthy references.

Interventions: Not applicable.

Main outcome measures: Modified Heckmatt scale ratings and quantitative gray-scale scores.

Results: Inter- and intra-rater intraclass correlation coefficients were 0.76 and 0.81, respectively (P<.001), indicating good to excellent reliability. A significant relationship was found between Modified Heckmatt scores and quantitative gray-scale scores (r=0.829; P<.001).

Conclusions: The Modified Heckmatt scale demonstrated good reliability and validity to assess the pathologic muscle changes that occur in patients with spasticity.

Keywords: BoNT, botulinum toxin; Botulinum toxins; CI, confidence interval; EI, echointensity; Fibrosis; ICC, intraclass correlation coefficient; MAS, Modified Ashworth scale; Muscle spasticity; Rehabilitation; Reproducibility of results; UMN, upper motor neuron; US, ultrasound; Ultrasonography.