Metric properties of the Tonic Stretch Reflex Threshold (TSRT) as a measure of spasticity: a systematic review with meta-analysis.
Diego Longo, Marco Baccini, Giulio Cherubini and 6 others
PMID 40989002WHAT IT FOUND
The Tonic Stretch Reflex Threshold is not reliable enough for clinical use.
Measurement error is too high to detect small changes in spasticity, and results correlate poorly with standard scales like the Modified Ashworth Scale. It should not replace existing assessments.
Key findings
01Intra-rater reliability was low (pooled ICC 0.548) with a minimal detectable change of 41 degrees.
02Correlation with clinical spasticity scales was weak and highly inconsistent (pooled rho -0.305).
03Responsiveness was rated insufficient, with one study failing to detect change against a clinical anchor.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Most included studies had a high risk of bias due to small sample sizes and methodological flaws. There was high heterogeneity in the measurement protocols across studies (e.g., different devices, stretch velocities, and EMG onset criteria). The review included only 19 studies, with very few evaluating reliability or responsiveness. Clinical scales used as comparators (MAS, CSI) also have questionable reliability, making validity assessments difficult.
Declared interests
The authors declared no conflicts of interest. Funders played no role in the study design, conduct, or reporting.
The easy way to misread this
Do not interpret the TSRT's ability to distinguish spastic patients from healthy controls as evidence it is useful for clinical monitoring. While it works for group comparisons, its high measurement error makes it unreliable for tracking changes in individual patients over time.
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