Interrater agreement in the assessment of motor manifestations of Huntington's disease.

Mov Disord 2005 Mar;20(3):293-7

Oregon Health and Science University, Portland, Oregon 97239-3098, USA.

With prospects improving for experimental therapeutics aimed at postponing the onset of illness in preclinical carriers of the Huntington's disease (HD) gene, we assessed agreement among experienced clinicians with respect to the motor manifestations of HD, a relevant outcome measure for preventive trials in this population. Seventy-five clinicians experienced in the evaluation of patients with early HD and six non-clinicians were shown a videotape compiled from the film archives of the United States-Venezuela Collaborative HD Research Project. Observers were asked to rate a 2-3-minute segment of the motor examination for each of 17 at-risk subjects. The rating scale ranged from 0 (normal) to 4 (unequivocal extrapyramidal movement disorder characteristic of HD). As measured by a weighted kappa statistic, there was substantial agreement among the 75 clinicians in the judgment of unequivocal motor abnormalities comparing scale ratings of 4 with ratings that were not 4 (weighted kappa = 0.67; standard error (SE) = 0.09). Agreement among the non-clinicians was only fair (weighted kappa = 0.28; SE = 0.10). Even under the artificial conditions of a videotape study, experienced clinicians show substantial agreement about the signs that constitute the motor manifestations of illness in subjects at risk for HD. We expect these findings to translate to a similar level of interobserver agreement in the clinical trial setting involving experienced investigators examining live patients.

Download full-text PDF

Source
http://dx.doi.org/10.1002/mds.20332DOI Listing
March 2005
23 Reads

Publication Analysis

Top Keywords

weighted kappa
12
motor manifestations
12
experienced clinicians
8
substantial agreement
8
huntington's disease
8
motor
5
agreement
5
motor examination
4
segment motor
4
2-3-minute segment
4
examination at-risk
4
agreement signs
4
subjects rating
4
scale ranged
4
videotape study
4
study experienced
4
rating scale
4
clinicians substantial
4
rate 2-3-minute
4
at-risk subjects
4

References

(Supplied by CrossRef)
Unified Huntington's Disease Rating Scale: reliability and consistency
Huntington Study Group et al.
Mov Disord 1996
A coefficient of agreement for nominal scales
Cohen et al.
Educ Psychol Meas 1960
Measuring pairwise interobserver agreement when all subjects are judged by the same observers
Schouten et al.
Stat Neerl 1982
A novel gene containing a trinucleotide repeat that is expanded and unstable on Huntington's disease chromosomes
Huntington's Disease Collaborative Research Group et al.
Cell 1993
Huntington's disease in Venezuela: 7 years of follow-up on symptomatic and asymptomatic individuals
Penney et al.
Mov Disord 1990
Subtle involuntary movements are not reliable indicators of incipient Huntington's disease
de Boo et al.
Mov Disord 1998
Trends in predictive and prenatal testing for Huntington disease 1993-1999
Nance et al.
Am J Hum Genet 1999
Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study
Fisher et al.
J Natl Cancer Inst 1998
Riluzole therapy in Huntington's disease
Rosas et al.
Mov Disord 1999

Similar Publications