Early Identification for Spasticity Patient Referral Needs: An Inter-Rater Reliability Study of the Post-Stroke Spasticity Referral Tool

Authors

• Jorg Wissel
• Atul Patel
• Ganesh Bavikatte
• Xiao Li
• Sophie L Musson
• Elizabeth Torres
• Nabilah Alibhai
• Tiziana Musacchio
• Gerard E Francisco

Language

English

Publication Date

12-1-2025

Journal

Expert Review of Neurotherapeutics

DOI

10.1080/14737175.2025.2580462

PMID

41193949

Abstract

Background: The post-stroke spasticity (PSS) Referral Tool was developed to assist health care professionals in the early identification of patient referral needs. An inter-rater reliability (IRR) study using videos of patients with different stages of or without predictors of PSS was performed to validate its utility in clinical practice.

Research design and methods: This prospective study had 3 parts: patient video production (Part A); expert panel classification of patient videos into PSS Referral Tool categories (Part B; Urgent Referral [UR; red], Routine Referral [RR; yellow], Periodic Monitoring [PM; green]), and an IRR analysis from global clinician raters (Part C). IRR was estimated using the intra-class correlation coefficient (ICC) with a 2-way random effect, absolute agreement, single-measurement model ( < 0.50 [poor]; 0.50-0.75 [moderate]; 0.76-0.90 [good]; > 0.90 [excellent]).

Results: In total, 50 raters participated and 70% had no prior experience using the PSS Referral Tool. IRR (ICC [95% CI]) was moderate (0.68 [0.53, 0.84]) and most video ratings were correct (UR/RR: 69.2% [173/250]; PM: 88.0% [220/250]). Sensitivity was highest in raters with no or moderate experience (93.3% [14/15]).

Conclusions: Irrespective of previous experience and geographic region of practice, the PSS Referral Tool accurately identified patients at risk for PSS.

Keywords

Humans, Muscle Spasticity, Stroke, Referral and Consultation, Reproducibility of Results, Prospective Studies, Female, Male, Middle Aged, Aged, Observer Variation, Early identification, inter-rater reliability, post-stroke spasticity, referral to treatment, rehabilitation, stroke

Published Open-Access

yes

Recommended Citation

Wissel, Jorg; Patel, Atul; Bavikatte, Ganesh; et al., "Early Identification for Spasticity Patient Referral Needs: An Inter-Rater Reliability Study of the Post-Stroke Spasticity Referral Tool" (2025). Faculty, Staff and Student Publications. 4303.
https://digitalcommons.library.tmc.edu/uthmed_docs/4303