Martín-Ávila Guillermo, Vieira-Campos Alba, Labrador-Marcos Sergio, Zheng Xiaochen, Méndez-Burgos Alejandro, Thuissard Israel, Andreu-Vázquez Cristina, Ordieres-Meré Joaquin, Aladro Yolanda
Department of Neurology, Hospital Universitario de Getafe, European University of Madrid, Spain.
Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain.
Parkinsonism Relat Disord. 2022 Mar;96:22-28. doi: 10.1016/j.parkreldis.2022.01.021. Epub 2022 Jan 29.
There are some validated rating scales to assess severity of Essential tremor (ET), the most common cause of action tremor. Clinical evaluation through telematic consultations has been expanding in the last decade. Patients' self-assessment of tremor severity at home could constitute a useful tool in telemedicine. This paper aims to assess intrarater and interrater reliability of ET severity using Fahn-Tolosa Marin Tremor Rating Scale (FTMTRS) for patients' and neurologists' ratings.
Patients were instructed on how to perform and rate the FTMTRS tasks. Supervised by neurologists, each patient performed one FTMTRS self-assessment at the hospital, which was rated in a blinded way by two neurologists, and six more self-assessments at home afterwards. Postural, intention and specific-tasks tremor were rated. A cumulative linked mixed model was used to assess intrarater and interrater reliability.
A total of 161 self-assessments from 19 patients were analyzed. Intrarater reliability of patients' self-ratings at home showed ICCs between 0.843 and 0.962. Interrater ICCs of neurologists' ratings were also excellent for all tremor types (0.903-0.987). Concordance between neurologists' and patients' assessments showed ICCs ranging from 0.407 to 0.824, with the higher agreement for writing/drawing-related tremor (0.824; CI 95% 0.634-0.989).
The rating of ET severity from FTMTRS self-assessments performed by well-trained patients at home could be a suitable clinical measure to assess tremor in non-face-to-face medical consultations. The assessment of tremor during specific tasks could be the most efficient measure for the patient self-assessment at home. These results could be useful in telemedicine.
有一些经过验证的评分量表可用于评估特发性震颤（ET）的严重程度，ET是动作性震颤最常见的病因。在过去十年中，通过远程医疗咨询进行的临床评估不断扩展。患者在家中对震颤严重程度的自我评估可能成为远程医疗中的一项有用工具。本文旨在使用法恩 - 托洛萨·马林震颤评分量表（FTMTRS）评估患者和神经科医生对ET严重程度评分的评分者内和评分者间信度。
指导患者如何执行FTMTRS任务并进行评分。在神经科医生的监督下，每位患者在医院进行一次FTMTRS自我评估，由两名神经科医生以盲法进行评分，随后患者在家中再进行六次自我评估。对姿势性、意向性和特定任务性震颤进行评分。使用累积链接混合模型评估评分者内和评分者间信度。
共分析了19名患者的161次自我评估。患者在家中自我评分的评分者内信度显示组内相关系数（ICC）在0.843至0.962之间。神经科医生评分的评分者间ICC对于所有震颤类型也都非常出色（0.903 - 0.987）。神经科医生和患者评估之间的一致性显示ICC范围为0.407至0.824，与书写/绘图相关震颤的一致性更高（0.824；95%置信区间0.634 - 0.989）。
训练有素的患者在家中进行FTMTRS自我评估对ET严重程度的评分，可能是在非面对面医疗咨询中评估震颤的合适临床措施。在特定任务期间对震颤的评估可能是患者在家中自我评估的最有效措施。这些结果可能对远程医疗有用。
