Research and Publications - Department of Health Science

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Browsing Research and Publications - Department of Health Science by Author "Adler, Charles H."

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    It's tricky: Rating alleviating maneuvers in cervical dystonia
    (Elsevier, 2020) Cisneros, Elizabeth; Stebbins, Glenn T.; Chen, Qiyu; Vu, Jeanne P.; Benadof, Casey N.; Zhang, Zheng; Barbano, Richard L.; Fox, Susan H.; Goetz, Christopher G.; Jankovic, Joseph; Jinnah, Hyder A.; Perlmutter, Joel S.; Adler, Charles H.; Factor, Stewart A.; Reich, Stephen G.; Rodriguez, Ramon; Severt, Lawrence L.; Stover, Natividad P.; Berman, Brian D.; Comella, Cynthia L.; Peterson, David A.; University of California San Diego; Rush University; University of Rochester; University of Toronto; University Health Network Toronto; Baylor College of Medicine; Emory University; Washington University (WUSTL); Mayo Clinic; University of Maryland Baltimore; Harvard University; Beth Israel Deaconess Medical Center; University of Alabama Tuscaloosa; Virginia Commonwealth University; Salk Institute
    Objectives: To investigate hypothesized sources of error when quantifying the effect of the sensory trick in cervical dystonia (CD) with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-2), test strategies to mitigate them, and provide guidance for future research on the sensory trick. Methods: Previous analyses suggested the sensory trick (or "alleviating maneuver", AM) item be removed from the TWSTRS-2 because of its poor clinimetric properties. We hypothesized three sources of clinimetric weakness for rating the AM: 1) whether patients were given sufficient time to demonstrate their AM; 2) whether patients' CD was sufficiently severe for detecting AM efficacy; and 3) whether raters were inadvertently rating the item in reverse of scale instructions. We tested these hypotheses with video recordings and TWSTRS-2 ratings by one "site rater" and a panel of five "video raters" for each of 185 Dystonia Coalition patients with isolated CD. Results: Of 185 patients, 23 (12%) were not permitted sufficient testing time to exhibit an AM, 23 (12%) had baseline CD too mild to allow confident rating of AM effect, and 1 site- and 1 video-rater each rated the AM item with a reverse scoring convention. When these confounds were eliminated in step-wise fashion, the item's clinimetric properties improved. Conclusions: The AM's efficacy can contribute to measuring CD motor severity by addressing identified sources of error during its assessment and rating. Given the AM's sensitive diagnostic and potential pathophysiologic significance, we also provide guidance on modifications to how AMs can be assessed in future CD research.