![]() ![]() ![]() Quantitative tremor evaluation is well-developed in research, but clinical application has lagged, in part due to cumbersome mathematical application and lack of established standards. Ordinal scales based on qualitative observation are the mainstay in the clinical assessment of tremor, but are limited by inter-rater reliability, measurement precision, range, and ceiling effects. Training of raters on use of the TRS would help standardize judgement. It is best when the same rater performs repeated measures of tremor on a patient, particularly when judging tremor in handwriting and drawings. The average Spearman correlation was 0.87, indicating very good consistency between the two videotapes, but correlations for Part A were somewhat better than for Part B. Interrater reliabilities were greater for Part A items (magnitude of tremor in different body parts) than for Part B items (tremor in writing and drawings) of the TRS. In the interrater reliability evaluation, modified Kappa statistics for seven tremor type composites ranged from 0.10 to 0.65 in the first videotape and 0.17 to 0.62 in the second videotape. Once the raters returned the videotape and completed the score sheet, they were mailed a second tape with the same recordings presented in a different order. Videotape recordings of 17 subjects with ET evaluated with the TRS were produced and sent to 59 raters. Proper treatment of ET is contingent upon correct assessment of the severity, loss of function, and disability related to tremor. The purpose of this study was to evaluate interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) in essential tremor (ET). ![]()
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