Reliability of the Five Step Assessment and Its Coefficients of Impairment in Spastic Paresis.
Marjolaine Baude, Maud Pradines, Caroline Gault-Colas and 6 others
PMID 40678290WHAT IT FOUND
The Five Step Assessment reliably measures four distinct drivers of spasticity in adults.
A full eight-muscle check takes about 18 minutes. Therapists can use it to distinguish muscle shortening from nerve-driven stiffness, guiding whether to stretch or train motor control.
Key findings
01The assessment showed good to excellent reliability when the same rater measured the same patients a week apart.
02Different raters agreed well on most measurements, but reliability for the fatigability coefficient was only moderate.
03Assessing eight muscle groups took an average of 18 minutes and was well tolerated by both patients and clinicians.
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
The study included only 18 participants, which limits how much you can generalize the reliability estimates to other settings. Most participants had vascular causes (stroke), so the reliability might differ for conditions like cerebral palsy or multiple sclerosis. The study tested reliability (consistency), not validity (whether it measures what it claims to measure). Raters were highly specialized experts in spasticity; reliability might be lower if used by clinicians with less experience.
Declared interests
Several authors have financial disclosures with companies that manufacture botulinum toxin and other spasticity treatments (Merz, Ipsen, Allergan), though they state these are not related to this specific study.
The easy way to misread this
Do not assume this tool is validated for measuring actual functional improvement or patient outcomes. It demonstrates that the measurements are consistent when repeated, but it does not prove that these specific angles and coefficients correlate with how well a patient can use their limb in daily life.