Learning curve using the Sunnybrook Facial Grading System in assessing facial palsy: An observational study in 100 patients

Abstract

Assessment of facial function in facial palsy patients is important to evaluate current status and treatment effect. The Sunnybrook Facial Grading System (SB) is one of the clinician grading's of facial function. 1 Inter-and intraobserver reliability ranges from 0.838 to 0.980 and 0.831 to 0.997, respectively. 2 However, most reliability studies included experienced observers. In research projects, facial palsy assessment is often done by medical students. Additionally, general practitioners and starting residents or physical therapists may not have extensive experience in facial palsy assessment using the SB.Aim of this study was to analyse a learning curve for facial function assessment in facial palsy using the SB in a 7-week prospective observational study with two inexperienced final-year medical students. | MATERIAL S AND ME THODS | Ethical considerationsThis study was performed at the University Medical Center Groningen, the Netherlands. No formal ethical review by the Institutional Review Board was required. All patients provided written consent prior to this study.

Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial

“…11,25 Although we did not assess interobserver agreement, our findings are aligned with previous studies that have found strongest interrater reliability of both the House-Brackmann and Sunnybrook scale among senior clinicians compared to juniors or inexperienced medical students. 26,27 Importantly, in a post hoc analysis we found that agreement between the 2 scales dropped from excellent to moderate when observations with a House-Brackmann score of I were removed from the analysis. This means that the scales moderately agree in patients with disease, and agreement improves in the absence of disease.…”

“…11,25 Although we did not assess interobserver agreement, our findings are aligned with previous studies that have found strongest interrater reliability of both the House-Brackmann and Sunnybrook scale among senior clinicians compared to juniors or inexperienced medical students. 26,27…”

Agreement of Clinician‐Administered and Modified Parent‐Administered House‐Brackmann Scales in Children with Bell's Palsy

“… 18 Greater variability in the assessment of facial function has been reported between senior clinicians compared to juniors and medical students. 19 , 20 Increasing familiarity with the scales and greater familiarity with facial movement deficits by parents may also explain the improving agreement over time. In our study some of the follow‐up assessments may have been conducted by a different caregiver from the one who completed the baseline assessment.…”

“…This shortcoming may be particularly relevant for the initial clinician assessment in the ED where junior clinicians may have graded participants. 19 , 20 We only assessed agreement between the scales in children with Bell's palsy though the results are likely applicable to other causes of FNP. The parent‐administered House‐Brackmann scale will need to be externally validated to support its broader use.…”

Novelty in the Impact of Physical Therapy in a Known Case of Right-Sided Grade V Facial Nerve Palsy: A Case Report

“…This scale includes 13 items, among which three are resting, five are related to voluntary movement, and five are about synkinesis movement. The total score ranges from 0-100, among which the score range for resting symmetry is 0-20, the score range for voluntary symmetry is 20-100, and synkinesis is 0-15 [8,9].…”