title: Reproducibility of a four-point clinical severity score for glabellar frown lines.
abstract: BACKGROUND
  Focal injections of botulinum toxin A are used successfully for the treatment of hyperkinetic facial wrinkles. Efficacy can be measured by several methods. However, so far none has been investigated for its reproducibility. Objectives To investigate the reproducibility of a clinical 0-3 score for glabellar frown lines.
  
  
  METHODS
  In the first part of the study, a standardized photographic documentation of glabellar frown lines was produced. Based on the results of this phase, a consensus atlas of glabellar frown lines was developed and participants were trained using this atlas. In the main study, 50 standardized photographs were shown on two consecutive days to 28 dermatologists. The reproducibility of the score was investigated by conventional kappa statistics.
  
  
  RESULTS
  In the main study, we found an unweighted kappa according to Fleiss of 0.62 for interobserver reproducibility. Intraobserver reproducibility showed an unweighted kappa according to Cohen of between 0.57 and 0.91 for each observer, and a weighted kappa according to Cicchetti and Allison of between 0.68 and 0.94.
  
  
  CONCLUSIONS
  The clinical 0-3 score for glabellar frown lines shows a good inter- and intraobserver reproducibility.
authors.affiliation: Medical School Mannheim, University of Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Honeck
authors.forename: C
authors.initials: C
authors.lastname: Weiss
authors.forename: W
authors.initials: W
authors.lastname: Sterry
authors.forename: B
authors.initials: B
authors.lastname: Rzany
mesh_terms: D005260:Female; D005546:Forehead; D006801:Humans; D008297:Male; D015588:Observer Variation; D010781:Photography / Q000592:standards; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015595:Skin Aging / Q000473:pathology*; D013223:Statistics as Topic; D016896:Treatment Outcome