Evidence map›Paper›PMID 40989002›Full record

ArticleArchives of physiotherapy

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, Aurora Caporaso, Mario De Marco, Angela Politi, Guido Santini, Francesca Cecchi, Maria Angela Bagni

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Article in Archives of physiotherapy. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Diego LongoDepartment of Experimental and Clinical Medicine, University of Florence, Florence - Italy.ORCID https://orcid.org/0000-0003-1776-6873
Marco BacciniIRCCS Fondazione Don Gnocchi Onlus, Florence - Italy.ORCID https://orcid.org/0009-0000-4494-0860
Giulio CherubiniDepartment of Experimental and Clinical Medicine, University of Florence, Florence - Italy.ORCID https://orcid.org/0009-0002-4591-4765
Aurora CaporasoBachelor's degree programme in Physiotherapy, University of Florence, Florence - Italy.ORCID https://orcid.org/0009-0000-7252-0919
Mario De MarcoDepartment of Experimental and Clinical Medicine, University of Florence, Florence - Italy.ORCID https://orcid.org/0000-0001-6253-7952
Angela PolitiIRCCS Fondazione Don Gnocchi Onlus, Florence - Italy.ORCID https://orcid.org/0000-0002-2801-1436
Guido SantiniDepartment of Experimental and Clinical Medicine, University of Florence, Florence - Italy.ORCID https://orcid.org/0009-0001-7165-3792
Francesca CecchiDepartment of Experimental and Clinical Medicine, University of Florence, Florence - Italy.
Maria Angela BagniDepartment of Experimental and Clinical Medicine, University of Florence, Florence - Italy.ORCID https://orcid.org/0000-0001-9692-3034

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Spasticity is a common symptom after brain injury, often interfering with functional recovery and rehabilitation. The Tonic Stretch Reflex Threshold (TSRT) was proposed as an objective neurophysiological assessment of spasticity that could overcome the limitations of clinical scales. This systematic review aimed to appraise the current evidence on the metric properties of TSRT. Methods: Electronic databases (MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE) were screened from inception to June 30, 2025, for studies reporting data on reliability, validity, and/or responsiveness of TSRT in adults with stroke. Two reviewers independently selected the studies, assessed the methodological quality, and extracted relevant data. When possible, pooled estimates for each property were computed. Results: Of the 9804 titles retrieved, 17 were eventually included, to which 2 articles from cross-references were added. We found insufficient values for both intra-rater (two studies, ICC = 0.548, 0.330-0.710) and inter-rater (three studies, ICC = 0.687, 0.511-0.808) reliability, with high measurement error. Data on validity were found in 14 articles, with conflicting results on the association of TSRT with clinical scales of spasticity and motricity, but good ability to discriminate among relevant groups. Only one study investigated responsiveness with an external anchor, finding that TSRT measurements failed to accurately detect improved participants. Conclusion: Despite the potential of TSRT as a measure of spasticity, its metric properties, particularly reliability, are not fully supported. Future research should prioritize improving its reliability and investigating its validity and responsiveness with neurophysiological measures rather than relying solely on clinical scales.

Indexed as

AdultMuscle spasticityReproducibility of resultsStretch reflexStroke

Identifiers

PMID40989002
PMCPMC12451295

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.