Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Temple

Abstract

BACKGROUNDA validated scale is needed for objective and reproducible comparisons of temple appearance before and after aesthetic treatment in practice and clinical studies.OBJECTIVETo describe the development and validation of the 5-point photonumeric Allergan Temple Hollowing Scale.METHODSThe scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 298) completed during 2 sessions occurring 3 weeks apart.RESULTSA score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.1 [0.94–1.26] for clinically different image pairs and 0.67 [0.51–0.83] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.86). Interrater agreement was almost perfect during the second session (0.81, primary endpoint).CONCLUSIONThe Allergan Temple Hollowing Scale is a validated and reliable scale for physician rating of temple volume deficit.

Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Hand

“…During the first and second live scale validation sessions, each physician rater evaluated all subjects on all scales (7 additional scales for other anatomic features were evaluated at the same sessions and are reported separately 12 – 18 ). Raters had separate evaluation stations with an examination lamp, table, and a stool for subject seating, supplies, and the photonumeric scale mounted and displayed for use in subject evaluation.…”

Performance of intraclass correlation coefficient (ICC) as a reliability index under various distributions in scale reliability studies

“…Detailed descriptions of the scale development process have been published. 28 As shown through reasonably small interdecile ranges for ICC in Table 7, a target sample size of n = 80 subjects for k = 8 raters was used for the sampling method. Subsets of 80 to 115 subjects with minimal non-uniformity across grades were randomly selected using the procedure described in Figure 2.…”

“…The example used for illustration in this paper is a multiple scales reliability study designed to validate 5 photonumeric scales for measuring volume deficits and aging in the following areas: forehead lines, fine lines, hand volume deficit, skin roughness, and temple hollowing. [24][25][26][27][28] Each of the 5 scales has 5 grades of severity (ie, 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = severe) to measure volume deficit and aging. Because multiple scales are being assessed simultaneously, it is difficult to obtain uniform distributions of subjects across all 5 grades of the 5 scales as is apparent in Table 1.…”

A photonumeric scale for the assessment of atrophic facial photodamage

“…Numerous photonumeric scales are published in the literature, each with a specific focus on different aspects of skin disease; photodamage and its constituents is no exception. [12][13][14] The photonumeric scale for hypertrophic cutaneous facial photodamage 8 is perhaps the best example. We have produced a similar photonumeric grading system to assess atrophic cutaneous facial photodamage.…”

“…Descriptive scales have historically proven to be less user‐friendly and a poorer assessment tool for photodamage. Numerous photonumeric scales are published in the literature, each with a specific focus on different aspects of skin disease; photodamage and its constituents is no exception . The photonumeric scale for hypertrophic cutaneous facial photodamage is perhaps the best example.…”