title: Clinicians' Tendencies to Under-Rate Parkinsonian Tremors in the Less Affected Hand.
abstract: The standard assessment method for tremor severity in Parkinson's disease is visual observation by neurologists using clinical rating scales. This is, therefore, a subjective rating that is dependent on clinical expertise. The objective of this study was to report clinicians' tendencies to under-rate Parkinsonian tremors in the less affected hand. This was observed through objective tremor measurement with accelerometers. Tremor amplitudes were measured objectively using tri-axis-accelerometers for both hands simultaneously in 53 patients with Parkinson's disease during resting and postural tremors. The videotaped tremor was rated by neurologists using clinical rating scales. The tremor measured by accelerometer was compared with clinical ratings. Neurologists tended to under-rate the less affected hand in resting tremor when the contralateral hand had severe tremor in Session I. The participating neurologists corrected this tendency in Session II after being informed of it. The under-rating tendency was then repeated by other uninformed neurologists in Session III. Kappa statistics showed high inter-rater agreements and high agreements between estimated scores derived from the accelerometer signals and the mean Clinical Tremor Rating Scale evaluated in every session. Therefore, clinicians need to be aware of this under-rating tendency in visual inspection of the less affected hand in order to make accurate tremor severity assessments.
authors.affiliation: The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea.
authors.forename: Hong Ji
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea.
authors.forename: Sang Kyong
authors.initials: SK
authors.lastname: Kim
authors.affiliation: The Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Park
authors.affiliation: The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea.
authors.forename: Han Byul
authors.initials: HB
authors.lastname: Kim
authors.affiliation: The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea.
authors.forename: Hyo Seon
authors.initials: HS
authors.lastname: Jeon
authors.affiliation: The Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Jung
authors.affiliation: The Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors.forename: Eungseok
authors.initials: E
authors.lastname: Oh
authors.affiliation: The Department of Neurology, Konkuk University Hospital, Seoul, Republic of Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: The Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yun
authors.affiliation: The Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Beom S
authors.initials: BS
authors.lastname: Jeon
authors.affiliation: The Department of Biomedical Engineering, Seoul National University, Seoul, Republic of Korea.
authors.forename: Kwang Suk
authors.initials: KS
authors.lastname: Park
mesh_terms: D061725:Accelerometry / Q000379:methods*; D000368:Aged; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis*; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis*