title: A Randomized, Blinded Study to Validate the Merz Hand Grading Scale for Use in Live Assessments.
abstract: BACKGROUND
  The Merz Hand Grading Scale (MHGS) is a 5-point scale used to grade appearance of the dorsum of the hand. The MHGS has been previously validated for assessment of photographed hands but not for live assessment.
  
  
  OBJECTIVE
  The purpose of this randomized, blinded study was to validate the MHGS for live assessment of the hands in the clinical setting.
  
  
  METHODS
  Three physician raters completed a scale qualification program that included MHGS training, ratings of standardized hand photographs, and statistical analysis for reliability. Eighty-four subjects (28 males, 30% Fitzpatrick skin Types IV-VI, mean age of 42 years), randomized to 2 live assessment sessions for independent and blinded observation of dorsa of their right hands, completed the study.
  
  
  RESULTS
  Overall MHGS intrarater weighted Kappa value was 0.74 (0.68-0.79 [CI 95%]). First- and second-time hand-rating agreement scores ranged from 64% to 75%. Interrater weighed Kappa values ranged from 0.59 to 0.71, representing between-rater paired results of each combination of raters.
  
  
  CONCLUSIONS
  High-weighted Kappa values and agreements demonstrate that consistency at different time points can be achieved individually and by different raters for live assessments. The MHGS is a suitable instrument for live assessment in the clinical setting.
authors.affiliation: *AboutSkin Dermatology and DermSurgery, Englewood, Colorado, and Department of Dermatology, University of Colorado, Aurora, Colorado; †Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada; ‡Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California; §Bay Area Laser Institute, San Francisco, California; ‖Merz North America, Raleigh, North Carolina; ¶Yardley, Pennsylvania; #San Francisco, California.
authors.forename: Joel L
authors.initials: JL
authors.lastname: Cohen
authors.forename: Alastair
authors.initials: A
authors.lastname: Carruthers
authors.forename: Derek H
authors.initials: DH
authors.lastname: Jones
authors.forename: Vic A
authors.initials: VA
authors.lastname: Narurkar
authors.forename: Martin
authors.initials: M
authors.lastname: Wong
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Cheskin
authors.forename: J Richard
authors.initials: JR
authors.lastname: Trout
authors.forename: David J
authors.initials: DJ
authors.lastname: Howell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003357:Cosmetic Techniques; D000067548:Dermal Fillers / Q000008:administration & dosage*; D005260:Female; D006225:Hand; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012060:Rejuvenation; D015203:Reproducibility of Results; D016037:Single-Blind Method; D015595:Skin Aging / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000067548:Dermal Fillers