Department of Physiotherapy, University of Seville, Avicena S/S, Seville, Spain.
J Eur Acad Dermatol Venereol. 2013 Jun;27(6):694-8. doi: 10.1111/j.1468-3083.2012.04536.x. Epub 2012 Apr 6.
'Hexsel, dal'Forno and Hexsel Cellulite Severity Scale' (CSS) was developed to evaluate cellulite with an objective and easy to apply tool. Objective Study CSS intra- and inter-observer reliability in a Spanish female population by evaluating patients' cellulite through photographs of their overall gluteofemoral zone as opposed to its creators who distinguished between buttocks and thigh.
Cellulite Severity Scale was applied to 27 women, evaluating gluteofemoral cellulite, differentiating between left and right. Evaluations were made by three expert examiners each at three times with a 1-week separation. Variables were the five CSS dimensions (number of evident depressions; depth of depressions; morphological appearance of skin surface alterations; grade of laxity, flaccidity, or sagging skin; and the Nürnberger and Müller classification scale), and the overall CSS score. Cronbach's alpha, intra-class correlation and item total correlation were analysed.
Cronbach's alpha values were 0.951 (right) and 0.944 (left). In the intra-observer reliability analysis, intra-class correlation coefficient ranged from 0.993 to 0.999 (P < 0.001) and in the inter-observer analysis were 0.937 (right) and 0.947 (left) (P < 0.001). Item total correlation showed all dimensions to be needed except grade of laxity, flaccidity or sagging skin (0.959 right; 0.955 left).
Cellulite Severity Scale has excellent reliability and internal consistency when used to evaluate cellulite on the buttocks and back of the thighs considered together. Nevertheless, the dimension grade of laxity, flaccidity or sagging skin does not contribute positively to the final consistency of the scale. This dimension needs to be analysed in greater depth in future studies.
“Hexsel、dal'Forno 和 Hexsel 橘皮组织严重程度量表”（CSS）旨在开发一种客观且易于应用的工具来评估橘皮组织。目的：通过评估患者臀部和大腿后侧整体臀股区域的照片，研究 CSS 在西班牙女性人群中的内部和观察者间可靠性，而不是像其创建者那样将臀部和大腿区分开来。
将 CSS 应用于 27 名女性，评估臀股部橘皮组织，区分左右侧。由三位专家评估员分别在三周内进行三次评估，每次评估间隔一周。变量包括 CSS 的五个维度（明显凹陷的数量；凹陷的深度；皮肤表面改变的形态外观；松弛、松弛或下垂皮肤的程度；以及纽伦堡和穆勒分类量表）和总体 CSS 评分。分析了克朗巴赫的α值、组内相关系数和项目总分相关性。
克朗巴赫的α值分别为 0.951（右侧）和 0.944（左侧）。在观察者内可靠性分析中，组内相关系数范围为 0.993 至 0.999（P < 0.001），在观察者间分析中分别为 0.937（右侧）和 0.947（左侧）（P < 0.001）。项目总分相关性显示除松弛、松弛或下垂皮肤的程度外，所有维度都需要（0.959 右侧；0.955 左侧）。
当评估臀部和大腿后侧一起考虑的橘皮组织时，CSS 具有极好的可靠性和内部一致性。然而，松弛、松弛或下垂皮肤的程度维度并没有对量表的最终一致性产生积极影响。该维度需要在未来的研究中进行更深入的分析。
