Cervical dystonia severity scale reliability study

Abstract

Cervical dystonia (CD) is characterized by sustained contractions of the neck musculature, resulting in abnormal head postures. The Cervical Dystonia Severity Scale (CDSS) was developed to provide a reliable measure of treatment response in patients with CD. The CDSS uses a protractor and wall chart to rate the severity of the head's deviation from neutral in each of three planes of motion (rotation, laterocollis, anterocollis/retrocollis), which is then scored in 5 degree intervals (1 degree to 5 degrees deviation = 1; 86 degree to 90 degrees deviation = 18). To test the reliability of the CDSS, four centers, each with two independent examiners, evaluated 42 patients with CD. At each site, each of the two examiners used the CDSS to evaluate the head position of each patient twice, on the same day, for a total of four evaluations. The kappa value for intra-examiner agreement was 0.94 (95% confidence limit of 0.900-0.972), indicating excellent intra-examiner reliability. The kappa value for interexaminer reliability was 0.79 for the first evaluation and 0.86 for the second evaluation (95% confidence limits of 0.668-0.920 and 0.790-0.920) indicating excellent interexaminer reliability. Thus, the CDSS was highly reliable in both intra-examiner and interexaminer scoring comparisons.

Designing Clinical Trials for Dystonia

“…The Burke-Fahn-Marsden Scale, Unified Dystonia Rating Scale, and Global Dystonia Rating Scale were developed to evaluate generalized dystonia, but are also used for other dystonia types [44,46]. The Tsui score [47], the Cervical Dystonia Severity Scale [48], the Cervical Dystonia Impact Profile [49], the Craniocervical Dystonia Questionnaire [50], and the Toronto Western Spasmodic Torticollis Rating Scale [51] have been developed for cervical dystonia; the Jankovic Rating Scale [52] is used for blepharospasm. These scales vary in their ease of use in the clinical setting and appropriateness for use in clinical trials [45].…”

Reduction of Cervical Dystonia After an Extended Course of Chiropractic Manipulation: A Case Report

“…30 These were the predominant presenting postural distortions of this case of CD (see Figs 1, 2, and 3) and they form the basis of at least 1 system designed to rate the severity of CD. 12 The patient was a 38-year-old man. He had gross anterior lateral cervical torticollis.…”

“…Documentation of the severity of his postural distortion was based on a modification of a postural rating scale that has been proven to be a reliable method to grade CD in clinical practice. 12 The Cervical Dystonia Severity Scale (CDSS) method utilizes a protractor and wall chart to grade the severity of the patient's head deviation from neutral in each of 3 planes of motion (axial, coronal, and sagittal). 3 The severity of the cervical dystonia is then scored in 58 intervals: mild or grade 1 = 18 to 58 of total deviation.…”

“…By far, the most striking aspect of the presentation is involuntary muscle activation that leads to gross postural distortion, motor tics, and twitches. 4,11,12 In cervical dystonia, the observed involuntary motor activation is confined to the head and neck musculature and leads to postural distortions in one or any combination of sagittal, coronal, and/or axial planes resulting in the appearance of torticollis. 12 Unlike the torticollis seen in orthopedic patients, the torticollis of CD is not fixed and the patient has some ability to override the involuntary muscle activation that creates the abnormal posture.…”

Cross-cultural adaptation of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) to Brazilian Portuguese

“…Patients may present with head deviations in one plane only or present complex movements of the head and neck around multiple axes 5 .…”