Reliability of the Severity subscale of the revised Toronto Spasmodic Torticollis Rating Scale (TWSTRS-2) (S15.001)

OBJECTIVE: To test the inter- and intra-rater reliability of the motor severity subscale of the revised Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-2) in cervical dystonia (CD) in a multicenter study. BACKGROUND: The TWSTRS scale is used as the standard scale to evaluate the severity of CD. The TWSTRS-2 was developed using a modified Delphi methodology to address the limitations of the standard TWSTRS. METHODS: Subjects with isolated CD were videotaped using a standardized protocol. Subjects were rated by the principal investigator (CLC) using a global scale from 0 (no dystonia) to 10 (severe dystonia). The subject videotapes were stratified for severity using this global scale and randomly assigned to blocks of 20 unique subjects and 5 repeated subjects. Raters included 11 dystonia experts. Each rated 2 blocks for a total of 45 unique and 5 repeat subjects. Intraclass correlation coefficients were used to assess rater agreement given the ordinal nature of the data. RESULTS: 209 CD subjects (73[percnt] women, age 59+10 years) were included from 10 sites. Inter-rater agreement for the total TWSTR-2 score was good (ICC = 0.70 [95th CI: 0.62-0.78]). Fair to excellent inter-rater agreement (ICC > 0.40) was found for rotation, laterocolis, anterocolis, retrocollis, lateral shift, tremor, shoulder elevation, range of motion and time at midline. Poor inter-rater agreement was found for sagittal shift, duration and sensory trick (ICC < 0.40). Intra-rater agreement for total TWSTRS-2 score was excellent (ICC = 0.75 [95th CI: 0.51-0.87]). Intra-rater agreement was fair to excellent for all items except sagittal shift and duration ( ICCs < 0.40). CONCLUSIONS: The overall agreement among and within raters is acceptable for the severity subscale of the TWSTR-2 scale. Examination of individual item agreement suggests either item modification or improved training may be required for sagittal shift, duration and sensory trick. Study Supported by: U54 NS065701 Disclosure: Dr. Comella has received personal compensation for activities with Ipsen, Merz, Allergan, Inc., Medtronic, Inc., Teva, US World Meds, Impax, and Acadia. Dr. Comella9s institution has received research support from Ipsen, Merz, Allergan, Inc., the National Chaper; of the APDA, HDSA, CHDI, Michael J. Fox Foundation, Ba Dr. Jinnah has received research support from Psyadon Pharmaceuticals, Inc. and Merz Pharma. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Goetz has received personal compensation for activities with Boston Scientific, CHDI, Centurion, ClearView, Frankel Group, and Ingenix. Dr. Goetz has received personal compensation in an editorial capacity for Oxford University Press, Elsevier Publish Dr. Adler has received personal compensation for activities with Merz, Novartis, Xenoport, Eli Lilly & Company, Teva, Acadia, and Lundbeck. Dr. Adler has received royalty payments from Springer. Dr. Barbano has received personal compensation for activities with Allergan as a consultant. Dr. Fox has received personal compensation for activities with Astra Zeneca, Merz, UCB Pharma, Novartis, Teva Neuroscience, Ipsen, and Zambon. Dr. Fox has received research support from Merck Serono and Avanir. Dr. Jankovic has received personal compensation for activities with Adamas Pharmaecuticals, Inc, Allergan, Inc, Auspex Pharmaceuticals, Inc, Lundbeck Inc, and Teva Pharmaceutical Industries Ltd. Dr. Jankovic has received personal compensation in an editor Dr. Rodriguez has received personal compensation for activities with Allergan, Inc., Merz Pharma, Lundbeck Research USA, Inc., and Teva Neuroscience as a consultant and/or advisory board participant. Dr. Severt has received personal compensation for activities with Teva Neuroscience, Allergan, Inc., Merz Pharma, Impax Laboratories, Novartis, and UCB Pharma as a speaker and/or advisory board member. Dr. Reich has received personal compensation for activities with Chelsea Therapeutics as a consultant. Dr. Reich has received royalty payments from Informa PLC. Dr. Reich has received research support from the National Institute of Neurological Disorders Dr. Stover has received research support from GlaxoSmithKline. Dr. Galpern has nothing to disclose. Dr. Rosen has nothing to disclose. Dr. Stebbins has nothing to disclose.