Task force report: Scales for screening and evaluating tremor: Critique and recommendations

Abstract

The Movement Disorder Society established a task force to review rating scales for the assessment of tremor. Screening instruments used in identifying patients with tremor were also reviewed. Seven tremor severity scales, six activities of daily living (ADL)/disability scales, four quality-of-life scales, and five screening instruments were identified by searching PubMed.gov. The availability, use, acceptability, reliability, validity, and sensitivity to change were reviewed for each scale; and each scale was classified as recommended, suggested or listed based on whether 3, 2, or 1 of the following criteria were met: (1) used in the assessment of tremor (yes/no), (2) used in published studies by people other than the developers (yes/no), and (3) successful clinimetric testing (yes/no). Five tremor severity scales (the Fahn-Tolosa-Marin Tremor Rating Scale, the Bain and Findley Clinical Tremor Rating Scale, the Bain and Findley Spirography Scale, the Washington Heights-Inwood Genetic Study of Essential Tremor Rating Scale, and the Tremor Research Group Essential Tremor Rating Assessment Scale), one ADL/disability scale (the Bain and Findley Tremor ADL Scale), one quality-of-life scale (the Quality of Life in Essential Tremor Questionnaire), and one screening instrument (the Washington Heights-Inwood Genetic Study of Essential Tremor Rating Scale, version 1) are recommended using these criteria. However, all scales need a more comprehensive analysis of sensitivity to change in order to judge their utility in clinical trials and individual patient assessments. The task force recommends that further work with existing recommended scales be performed as opposed to the development of new tremor scales.

White matter measures correlate with essential tremor severity—A pilot diffusion tensor imaging study

“…While the absence of correlation between diffusion measurements and clinical ET rating scales in our study corroborates two previous DTI studies conducted on the larger sample of 22 and 25 ET patients (Nicoletti et al., 2010; Saini et al., 2012), others showed significant association between frontoparietal WM and Fahn score in smaller samples of 14 and 19 ET patients, respectively (Klein et al., 2011; Pelzer et al., 2017). These discrepancies may be explained by lower inter‐rater reliability and the subjective nature of the clinical rating scales (Elble et al., 2013). We cannot exclude that the correlation with clinical rating scales could be detected on larger ET populations, although our sample shows significant relationships between WM and objective tremor measures but no association with clinical scales after exclusion of outliers and thus suggests that objective tremor measures reflect WM deficits.…”

“…Several DTI studies (Klein et al., 2011; Nicoletti et al., 2010; Pelzer et al., 2017; Saini et al., 2012) utilized clinical rating scales (e.g., Fahn‐Tolosa‐Marin [FTM] and Bain scales) as a measure of tremor severity; however, only two studies found a correlation between the FTM score and frontoparietal WM microstructure (Klein et al., 2011; Pelzer et al., 2017). The lower inter‐rater reliability and the subjective nature of the clinical rating scales (Elble et al., 2013) can be mitigated by objective accelerometry measures (i.e., the tremor frequency and amplitude), which may provide a more accurate representation of the disease pathophysiological features. This is suggested by recent functional and morphometric MRI studies (Gallea et al., 2015; Popa et al., 2013).…”

TREMOR12: An Open-Source Mobile App for Tremor Quantification

“…To measure treatment effect, most studies rely on clinical rating scales such as the Essential Tremor Rating Scale (ETRS) or the Bain and Findley Rating Scale in case of essential tremor, or the MDS-UPDRS in case of Parkinson's disease [1,2]. Tremor quantification can be done with electromyography, but this approach limits patients' mobility and is not suited for measurements in daily living.…”

Medical and Surgical Treatment of Tremors

“…In a recent review by an MDS task force, 13 Of these, the FTM tremor rating scale 14,15 incorporates evaluation of tremor (9 items, each rated 0 to 4), assessment of hand function (writing and pouring) (5 items), and ADLs (7 items). The new TETRAS scale 16 contains 9 performance items to rate action tremor in the head, face, voice, limbs, and trunk from 0 to 4 in half-point intervals.…”