Background
The Essential Tremor (ET) Rating Assessment Scale (TETRAS) has shown excellent inter- and intra-rater reliability. To assess the scale’s ability to detect changes in tremor severity, we compared TETRAS performance with standard postural tremor accelerometry during a standardized ethanol challenge.
Methods
Fifteen adult ET patients received a single oral ethanol dose calculated to reach 0.05 g/dl breath alcohol content (brAC) on two different study days. Two investigators independently assessed the effects with accelerometry on one day and with TETRAS on another day. Measurements were taken at 8 time-points (2 time-points baseline and 6 time-points up to 2 hours post ethanol). Further outcome measures included brAC readings at the same time points.
Results
Because correlation between TETRAS and accelerometry revealed a logarithmic relation, for all comparisons, accelerometry data were log-transformed and a cumulative score logACC(R+L) was calculated. Correlation between logACC(R+L) and TETRAS was significant (r= 0.57, p<0.01). Repeated measures ANOVA for both TETRAS and accelerometry before and after ethanol showed a significant effect of time-point (F=34.6, p<0.01; F=13.5, p<0.01). Corrected post-hoc tests showed a difference between baseline and each of the following 6 time-points. TETRAS and brAC were significantly correlated (r=−0.29, p<0.01). Intra-rater test-retest analysis between baseline measures showed high correlation (ICC=0.974, p<0.001). The ethanol challenge showed excellent reproducibility.
Conclusion
We demonstrated sensitivity of the TETRAS performance scale to change after a therapeutic intervention. Our study provides responsiveness validity for TETRAS, further establishing its potential as a valid instrument for ET evaluation in both clinical and research settings.
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