Objectives: Evaluate intra-rater and inter-rater variabilities of the Sunnybrook Facial Grading System (SFGS) and identify potential factors of variability. Study design: Prospective test of hypothesis.Setting: University tertiary referral centre.Participants/Methods: Facial video recordings of 20 patients with variable degrees of peripheral facial palsy (PFP) were anonymized then randomly presented to 31 independents raters in two 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 paralyses.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 synkinesis (0.810 [0.778-0.838]). The inter-rater ICC for the composite score was 0.847 [0.755-0.923] indicating almost perfect agreement between all raters. Agreement between raters was almost perfect for voluntary movements (0.839 [0.746-0.919]), but moderate for symmetry at rest (0.553 [0.408-0.730]) and synkinesis (0.476 [0.333-0.666]). Some differences were 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.
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