Movement disorders clinical practice · 2026
Interrater and Intrarater Reliability of the TWSTRS-Delphi Motor Severity Scale for Cervical Dystonia.
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Stebbins Glenn T, Adler Charles H, Albanese Alberto, Barbano Richard L, Bentivoglio Anna Rita, Colosimo Carlo, Contarino Maria Fiorella, Dressler Dirk, Factor Stewart A, Fox Susan H, Fung Victor S C, Goetz Christopher G, Jankovic Joseph, Jinnah Hyder A, Jost Wolfgang H, Tijssen Marina A J, Moro Elena, Perlmutter Joel S, Reich Stephen G, Rodriguez Ramon L, Severt Lawrence, Stover Natividad P, Vidailhet Marie, Lee Julianne, Comella Cynthia L, Peterson David A
Аннотация
BACKGROUND: Cervical dystonia (CD) motor severity is typically quantified with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). An expanded version of the Motor Severity section of the TWSTRS ("TWSTRS-Delphi") has been previously evaluated for its clinimetric properties but not for inter- and intrarater reliability.
OBJECTIVE: In this study we quantified inter- and intrarater reliability of the Motor Severity section of the TWSTRS-Delphi for CD.
METHODS: Ten raters familiar with the TWSTRS-Delphi and ten raters unfamiliar with it independently scored standardized videos from 90 patients with CD. We computed one-way random intraclass correlation coefficient (ICC, absolute agreement) for total and item scores. We repeated assessments and calculations with a subset of raters to assess intrarater reliability.
RESULTS: Interrater reliability for the Total score was good for Familiar raters (ICC = 0.697) and fair for Unfamiliar raters (ICC = 0.566). Most individual items achieved fair-excellent interrater agreement in both groups (Familiar 0.415-0.763; Unfamiliar 0.416-0.769). Sagittal Shift, Duration, and Sensory Tricks showed poor agreement. Intrarater reliability was fair-excellent for most items in both groups (Familiar 0.494-0.927; Unfamiliar 0.413-0.877), but poor for Sagittal Shift and Duration among Familiar raters.
CONCLUSIONS: The TWSTRS-Delphi yields reproducible Total and item scores across movement disorder raters. The data pinpoint Sagittal Shift, Duration, and Sensory Tricks as the principal sources of between-rater variability, defining immediate priorities for scale modification and focused training.
OBJECTIVE: In this study we quantified inter- and intrarater reliability of the Motor Severity section of the TWSTRS-Delphi for CD.
METHODS: Ten raters familiar with the TWSTRS-Delphi and ten raters unfamiliar with it independently scored standardized videos from 90 patients with CD. We computed one-way random intraclass correlation coefficient (ICC, absolute agreement) for total and item scores. We repeated assessments and calculations with a subset of raters to assess intrarater reliability.
RESULTS: Interrater reliability for the Total score was good for Familiar raters (ICC = 0.697) and fair for Unfamiliar raters (ICC = 0.566). Most individual items achieved fair-excellent interrater agreement in both groups (Familiar 0.415-0.763; Unfamiliar 0.416-0.769). Sagittal Shift, Duration, and Sensory Tricks showed poor agreement. Intrarater reliability was fair-excellent for most items in both groups (Familiar 0.494-0.927; Unfamiliar 0.413-0.877), but poor for Sagittal Shift and Duration among Familiar raters.
CONCLUSIONS: The TWSTRS-Delphi yields reproducible Total and item scores across movement disorder raters. The data pinpoint Sagittal Shift, Duration, and Sensory Tricks as the principal sources of between-rater variability, defining immediate priorities for scale modification and focused training.