Leeds Adult Spasticity Impact Scale (LASIS)

Purpose

The Leeds Adult SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
Impact Scale (LASIS) is a measure of passive arm function, suitable for patients with spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
and little or no active movement of the upper extremity.

In-Depth Review

Purpose of the measure

The Leeds Adult SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
Impact Scale (LASIS) is a measure of passive arm function that is administered by semi-structured interview to the patient or carer. It consists of 12 items of low difficulty that evaluate performance of daily functional tasks in the individual’s normal environment. The LASIS is useful for patients with minimal or no active movement or function but with self-care issues of the upper extremity (Ashford et al., 2008).

Available versions

The LASIS was originally published as the Patient Disability and Carer Burden Scale by Bhakta et al. (1996), which included 8 patient items and 4 carer items (Bhakta et al., 2000). The four carer items have been excluded from the current version of the LASIS.

Features of the measure

Items:

The LASIS consists of 12 items that measure passive and low-level active function.

Passive function items:

• Cleaning the palm (affected hand)*
• Cutting fingernails (affected hand)*
• Cleaning the affected elbow*
• Cleaning the affected armpit*
• Cleaning the unaffected elbow*
• Putting arm through coat sleeve*
• Difficulty putting on a glove
• Difficulty rolling over in bed
• Doing physiotherapy exercises to arm*

Active function items:

• Difficulty balancing in standing*
• Difficulty balancing when walking*
• Hold object steady, use other hand (jar)

* Items originally included in the Patient Disability and Carer Burden Rating Scale (Bhakta et al., 2000).

Scoring:

Items are rated between 0 – 4 according to the following criteria:

• 0 = No difficulty
• 1 = Little difficulty
• 2 = Moderate difficulty
• 3 = A great deal of difficulty
• 4 = Inability to perform the activity

The total score is calculated as the sum of individual scores, divided by the total number of questions answered. This results in a total score between 0 – 4 that represent disability or carer burden (Ashford et al., 2008).

Note: As the final score does not rely on responses to all 12 items, it may not reflect actual disability or function in the arm (Ashford et al., 2008).

Description of tasks:

The LASIS is administered through semi-structured interview with the patient or carer, with regard to the patient’s performance of tasks over the past 7 days.

Time:

The LASIS takes approximately 10 minutes to administer (Ashford et al., 2008).

Training requirements:

The LASIS should be administered by a clinician (Ashford et al., 2008).

Equipment:

Equipment such as a jar may be required to validate responses.

Alternative form of the Leeds Adult Spasticity Impact Scale (LASIS)

None reported.

Client suitability

Can be used with:

• Patients with spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
  , including patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Should not be used with:

• None reported.

Languages of the measure

No translations reported.

Summary

What does the tool measure?	Passive and low-level active function of the upper limb.
What types of clients can the tool be used for?	Patients with upper limb spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke. , including patients who have experienced a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment tool
Time to administer	10 minutes
Versions	The LASIS was originally published as the Patient Disability and Carer Burden Scale, which included four dressing and grooming items that have been excluded from the current version of the LASIS.
Other Languages	None reported
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: No studies have reported on the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the LASIS. Test-retest: No studies have reported on the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the LASIS. Intra-rater: No studies have reported on the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings. of the LASIS. Inter-rater: No studies have reported on the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. of the LASIS.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: No studies have reported on the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. of the LASIS. Criterion: Concurrent: No studies have reported on the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” of the LASIS. Predictive: No studies have reported on the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks. of the LASIS. Construct: Convergent/Discriminant: No studies have reported on the convergent/discriminant validityThe degree to which an assessment measures what it is supposed to measure. of the LASIS. Known Groups: No studies have reported on the known-groups validityThe degree to which an assessment measures what it is supposed to measure. of the LASIS.
Floor/Ceiling Effects	No studies have reported on the floor or ceiling effects of the LASIS.
Does the tool detect change in patients?	No studies have reported on the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” of the LASIS in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Acceptability	The LASIS is useful for patients with minimal or no active movement or function of the upper extremity.
Feasibility	Administrative burden due to calculation of total score, but not complex.
How to obtain the tool?	Further information can be found here.

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the Leeds Adult SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
Impact Scale (LASIS). At the time of publication no studies have reported on the psychometric properties of the LASIS in the strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. population.

Floor/Ceiling Effects

While no studies have investigated the floor or ceiling effects of the LASIS when used with a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. population, it ca be anticipated that ceiling effects may exist when the LASIS is used with high-functioning patients, due to the hierarchical relationship of items (Ashford et al., 2008).

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
No studies have reported on the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the LASIS.

Test-retest:
No studies have reported on the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the LASIS.

Intra-rater:
No studies have reported on the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the LASIS.

Inter-rater:
No studies have reported on the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the LASIS.

Validity

Content:

No studies have reported on the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the LASIS.

Criterion:

Concurrent:
No studies have reported on the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the LASIS.

Predictive:
No studies have reported on the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the LASIS.

Construct:

Convergent/Discriminant:
No studies have reported on the convergent/discriminant validityThe degree to which an assessment measures what it is supposed to measure.
of the LASIS.

Known Group:
No studies have reported on the known-groups validityThe degree to which an assessment measures what it is supposed to measure.
of the LASIS.

Responsiveness

No studies have reported on the responsivenessThe ability of an instrument to detect clinically important change over time.
of the LASIS.

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
/Specificity:
No studies have reported on the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
or the specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the LASIS.

References

• Ashford, S., Slade, M., Malaprade, F., & Turner-Stokes, L. (2008). Evaluation of functional outcome measures for the hemiparetic upper limb: A systematic review. Journal of Rehabilitation Medicine, 40, 787-95.
• Bhakta, B.B., Cozens, J.A., Chamberlain, M.A., & Bamford, J.M. (2000). Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. Journal of Neurological Neurosurgery and Psychiatry, 69, 217-21.

See the measure

How to obtain the LASIS?

Further information can be found here.