Sunnybrook Facial Grading System: Intra-rater and Inter-rater Variabilities.

OBJECTIVES: Evaluate intra-rater and inter-rater variabilities of the Sunnybrook Facial Grading System (SFGS) and explore potential factors of variability. STUDY DESIGN: Prospective test of hypothesis. SETTING: University tertiary referral center. PARTICIPANTS/METHODS: Facial video recordings of 20 patients with variable degrees of peripheral facial palsy (PFP) were anonymized then presented to 31 independents raters in 2 trials. The raters were senior and junior professionals involved in the management of PFP: ENT specialists, physiotherapists, and speech therapists. The SFGS was used for grading paralysis. MAIN OUTCOME MEASURE: Intra-rater and inter-rater variabilities were estimated by intraclass correlation coefficient (ICC [95% confidence interval]) for the composite score and the three subscores of the SFGS. Factors of variability studied were: rater professions and rater experience (senior vs junior). RESULTS: For the total population, the intra-rater ICC was 0.915[0.900-0.929] for the composite score considered to represent almost perfect repeatability. Repeatability was important for symmetry at rest (0.694[0.646-0.737]), almost perfect for voluntary movements (0.903[0.886-0.918]), and important to almost perfect for synkinesis (0.810[0.778-0.838]). The inter-rater ICC for the composite score was 0.847[0.755-0.923] indicating important to almost perfect agreement between all raters. Agreement between raters was important to almost perfect for voluntary movements (0.839[0.746-0.919]), but moderate to important for symmetry at rest (0.553[0.408-0.730]) and weak to important for synkinesis (0.476[0.333-0.666]). Some variability was found between raters groups; however, repeatability and agreement were good for all raters. CONCLUSIONS: The SFGS is a reproducible scale. It can be used with good reproducibility by both novices and experts, and by all professionals involved in the management of PFP.

Validation of French versions of the Facial Disability Index and the Facial Clinimetric Evaluation Scale, specific quality of life scales for peripheral facial palsy patients.

OBJECTIVES: To translate and validate French versions of two health-related quality of life questionnaires for patients with peripheral facial palsy: Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale. DESIGN: Prospective cohort study. SETTING: University tertiary referral centre. PARTICIPANTS: A pilot test was performed on 10 subjects (5 patients with facial palsy of more than 1-month duration and 5 normal subjects), and then 67 adult patients with facial palsy were enrolled in the validation study. MAIN OUTCOME MEASURES: Translation of the original questionnaires has followed international guidelines using a forward-backward translation method. A pilot test and a validation study based on the translated questionnaires were performed. Internal consistency, test-retest reliability, validity and responsiveness were assessed. Validity was assessed by comparing to SF-36 and Sunnybrook/House-Brackmann grading systems. Subjects answered scales twice within a one-week interval. RESULTS: Sixty-seven patients were enrolled, among which 63 completed scales one week later (retest). For physical and social functions of FDI and FaCE scores, Cronbach's α representing internal consistency was 0.88, 0.70 and 0.89, and test-retest reliability by intra-class correlation coefficients was 0.81, 0.86 and 0.89, respectively. The correlation of facial movement score of FaCE scale was good with Sunnybrook/House-Brackmann grading systems (0.73 and -0.75, P < 0.01). The correlation of social function of FaCE scale was excellent with social function of SF-36 (0.8, P < 0.01). CONCLUSIONS: French versions of FDI and FaCE scale are psychometrically valid. Both questionnaires can be used for clinical studies to assess the quality of life of patients with peripheral facial palsy.

Risk management and legal issues with the use of social media in the healthcare setting.

Social media have infiltrated all of our lives, both personally and professionally. Most of us could never have envisioned the impact that social media have had on us, particularly in the healthcare arena. Who would have thought even five years ago that a discussion on the ASHRM exchange would involve the use of Twitter in the operating room or that a physician would be reprimanded by a state medical board and have her privileges revoked due to posting information online about a trauma patient? In the coming years, social media use will only increase, causing concern for risk managers across the continuum. Furthermore, although case law and statutory regulations addressing the use of social media are minimal today, it is anticipated that we will see legal challenges to this evolving medium in the future.