Abstract Details

Title Reliability of the Essential Tremor Rating Assessment Scale in Untrained Neurology Residents

Topic Movement Disorders

Presentation(s) S53 - (-)

Poster/Presentation
Number 006

Objective

Background The Essential Tremor Rating Assessment Scale (TETRAS) was developed by the Tremor Research Group (TRG). The performance subscale of TETRAS consists of nine items in which peak-to-peak action tremor is rated 0-4 in half-point intervals, and tremors in the head, face, voice, limbs and trunk are assessed. Each rating of head tremor and limb tremor is defined by a specific amplitude range in centimeters, so as to make the ratings more objective. High inter- and intra-rater reliabilities were found in a study of ten movement disorder specialists (Elble et al. Mov Disord 2012: in press).

Design/Methods Videotaped TETRAS performance exams of two normal adults and 10 essential tremor patients were scored by 5 neurology residents (2 PGY4, 2 PGY3 and 1 PGY2) with no prior training in this or other tremor scales. Five developers of TETRAS, all movement disorder specialists, scored the same 12 videos. The twelve videos (different sequence and labels) were scored again, 1-2 months later. Inter- and intra-rater reliabilities were assessed with a two-way random effects intraclass correlation (ICC), using an absolute agreement definition.

Results The inter- and intra-rater intraclass correlations for head tremor and upper limb tremor ranged from 0.74 to 0.96, and the inter- and intra-rater intraclass correlations for the total score were 0.91 and 0.97. The intraclass correlations for voice, face, trunk and lower limb tremor were less robust. The residents and experts did not differ statistically in their inter- and intra-rater reliabilities.

Conclusions This scale is an exceptionally reliable tool for the clinical assessment of essential tremor, and exceptional reliability is achievable with no training in TETRAS or other tremor rating scales.

Authors/Disclosures
Rodger J. Elble, MD, PhD, FAAN (Southern IL Univ Sch of Med) PRESENTER	Dr. Elble has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz. Dr. Elble has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sage . Dr. Elble has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ES Therapeutics. Dr. Elble has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Applied Therapeutics. Dr. Elble has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Praxis.
Pavan Bhargava, MD, FAAN (Johns Hopkins University)	The institution of Dr. Bhargava has received research support from EMD Serono. The institution of Dr. Bhargava has received research support from Amylyx pharmaceuticals. The institution of Dr. Bhargava has received research support from Genentech. The institution of Dr. Bhargava has received research support from GSK.
Laxmi P. Dhakal, MD	No disclosure on file
Pankaj Jalan, MD, MBBS, FAAN (Norvic International Hospital)	No disclosure on file
Siddharth Kaul, MD, PhD (SSM Neurosciences)	No disclosure on file
Vijay M. Pandav, MBBS (Advent Health Daytona Beach)	No disclosure on file
Kelly E. Lyons, PhD (University of Kansas Medical Center)	Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sage. Dr. Lyons has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Parkinson's Foundation. Dr. Lyons has a non-compensated relationship as a President with International Essential Tremor Foundation that is relevant to AAN interests or activities.
	No disclosure on file
William Ondo, MD (Methodist Neurological Institute)	Dr. Ondo has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Neurocrine. Dr. Ondo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ACADIA. Dr. Ondo has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie. Dr. Ondo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kyowa Kirin. The institution of Dr. Ondo has received research support from Cerevel. The institution of Dr. Ondo has received research support from SCION. The institution of Dr. Ondo has received research support from Harmony. Dr. Ondo has received publishing royalties from a publication relating to health care.
Rajesh Pahwa, MD, FAAN (University of Kansas Medical Center)	Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AbbVie. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ACADIA. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amneal. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Supernus. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Insightec. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jaaz. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Fasikl. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genetech. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Mitsubishi Tanabe. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Photopharmics. The institution of Dr. Pahwa has received research support from Abbott. The institution of Dr. Pahwa has received research support from Abbvie. The institution of Dr. Pahwa has received research support from Biogen. The institution of Dr. Pahwa has received research support from Parkinson Foundation. The institution of Dr. Pahwa has received research support from Roche. The institution of Dr. Pahwa has received research support from Sage. The institution of Dr. Pahwa has received research support from Sun Pharma. The institution of Dr. Pahwa has received research support from Theravance. The institution of Dr. Pahwa has received research support from Neuroderm. The institution of Dr. Pahwa has received research support from Ask Bio. The institution of Dr. Pahwa has received research support from Blue Rock. The institution of Dr. Pahwa has received research support from Cerevance. The institution of Dr. Pahwa has received research support from Fasikl. The institution of Dr. Pahwa has received research support from Scion. The institution of Dr. Pahwa has received research support from UCB. The institution of Dr. Pahwa has received research support from Ono. The institution of Dr. Pahwa has received research support from Intra-cellular Therapies. The institution of Dr. Pahwa has received research support from Ask Bio. The institution of Dr. Pahwa has received research support from Michael J Fox Foundation . The institution of Dr. Pahwa has received research support from Neuron 23. The institution of Dr. Pahwa has received research support from Roche.
Kapil D. Sethi, MD, FRCP (UK), FAAN	Dr. Sethi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurocrine.
Daniel Tarsy, MD, FAAN	No disclosure on file
Ron Tintner, MD, FAAN	No disclosure on file

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