Rating scales for dystonia: A multicenter assessment

The evaluation of dystonia requires a reliable rating scale. The widely used Fahn‐Marsden Scale (F‐M) has not been sufficiently tested across multiple centers and investigators. The Dystonia Study Group developed the Unified Dystonia Rating Scale (UDRS) and a Global Dystonia Rating Scale (GDS) to se...

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Bibliographic Details
Published in:Movement disorders 2003-03, Vol.18 (3), p.303-312
Main Authors: Comella, Cynthia L., Leurgans, Sue, Wuu, Joanne, Stebbins, Glenn T., Chmura, Teresa
Format: Article
Language:English
Subjects:
Biological and medical sciences
Diseases of striated muscles. Neuromuscular diseases
dystonia
Dystonia - diagnosis
Female
Humans
Male
Medical sciences
Middle Aged
movement disorder
Neurology
Observer Variation
outcome assessment
rating scale
Reproducibility of Results
Severity of Illness Index
Videotape Recording
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Summary:The evaluation of dystonia requires a reliable rating scale. The widely used Fahn‐Marsden Scale (F‐M) has not been sufficiently tested across multiple centers and investigators. The Dystonia Study Group developed the Unified Dystonia Rating Scale (UDRS) and a Global Dystonia Rating Scale (GDS) to serve as instruments to assess dystonia severity. In this study, 25 dystonia experts evaluated the UDRS, F‐M, and GDS for internal consistency and reliability. One hundred dystonia patients were videotaped using a standardized videotape protocol. Each examiner rated 20 patients using the UDRS, F‐M, and GDS in random order. The examiner then assessed each scale for ease of use. Statistical analysis used Cronbach's α, intraclass correlation coefficients (ICC), generalized weighted κ statistic, and Kendall's coefficient of concordance. The UDRS, F‐M, and GDS showed excellent internal consistency (Cronbach's α 0.89–0.93) and good to excellent correlation among the raters (ICC range from 0.71–0.78). Inter‐rater agreement was fair to excellent (Kendall's 0.54–0.87; κ 0.37–0.91) being lowest for eyes, jaw, face, and larynx. The modifying ratings (Duration in the UDRS and Provoking Factor in the F‐M) showed less agreement than the motor severity ratings. Among scales, the total scores correlated (Pearson's r, 0.977–0.983). Overall, 74% of raters found the GDS the easiest to apply. The GDS with its simplicity and ease of application may be the most useful dystonia rating scale. © 2002 Movement Disorder Society
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.10377