A Validated Grading Scale for Forehead Lines

Abstract

The 5-point photonumeric scale generated spans the severity of forehead lines for which patients commonly seek correction. The scale is well stratified for consistent rating.

Performance of intraclass correlation coefficient (ICC) as a reliability index under various distributions in scale reliability studies

“…Thus, the estimator $\hat{\rho }$ can be derived as 3$\hat{\rho }=\frac{{\hat{\sigma }}_a^2}{{\stackrel{true^}{\sigma }}_a^2+{\stackrel{true^}{\sigma }}_b^2+{\stackrel{true^}{\sigma }}_{\mathit{ab}}^2+{\stackrel{true^}{\sigma }}_{ϵ}^2}=\frac{\mathrm{italicBMS}-\mathrm{italicEMS}}{\mathrm{italicBMS}+\left(k-1\right)\mathrm{italicEMS}+\frac{k}{n}\left(\mathrm{italicJMS}-\mathrm{italicEMS}\right)}$where (a) BMS is the between‐subjects mean square in 4 and refers to the departure of the mean grade across repeated ratings on the i th subject from the overall mean; (b) JMS is the between‐raters mean square in 5 and refers to the departure of the mean across repeated ratings of the j th rater from the overall mean; and (c) EMS is the residual mean square in 6 and refers to the departure of the j th rater from their usual ratings on the i th subject. $\mathrm{italicBMS}=\frac{k{\sum }_{i=1}^n{\left({\overline{x}}_{i.}-{\overline{x}}_{..}\right)}^2}{n-1}$ $\mathrm{italicJMS}=\frac{n{\sum }_{j=1}^k{\left({\overline{x}}_{.j}-{\overline{x}}_{..}\right)}^2}{k-1}$ $\mathrm{italicEMS}=\frac{{\sum }_{i=1}^n{\sum }_{j=1}^k{\left(x_{\mathrm{italicij}}-{\overline{x}}_{i.}-{\overline{x}}_{.j}+{\overline{x}}_{..}\right)}^2}{\left(n-1\right)\left(k-1\right)}$…”

“…Meanwhile, the uniform distribution has an unambiguous definition with equal percentages of subjects across grades, making it straightforward to compare results across scales and across studies. For some scale reliability studies, this consideration can be addressed by preselecting subject images to ensure uniform distributions across scale grades5, 7, 8, 12, 16; this structure ensures that each grade in the scale is well represented, and the full range of the scale is utilized, explored, and evaluated, as desired in instrument design and testing 37. However, this structure may not be feasible for studies addressing multiple scales with different distributions.…”

“…Scales that are a combination of phrases and photographs are known as photonumeric scales. In aesthetic studies, some examples of scales are measures for the degree of wrinkling,3, 4, 5, 6, 7, 8 lip fullness,9, 10, 11, 12 sagging,13 photodamage,14 and dyspigmentation,15 and they have been developed and evaluated using reliability indexes. In many aesthetic scale reliability studies, ICC is used to determine consistency, where a higher ICC signifies better consistency 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 16…”

Safety and Effectiveness of Focused Cold Therapy for the Treatment of Hyperdynamic Forehead Wrinkles

“…At each assessment, the investigator and subject assessed horizontal forehead and glabellar wrinkle severity both at rest and full contraction using the 5WS or 5GS (0 = no wrinkles, 1 = minimal wrinkles, 2 = mild wrinkles, 3 = moderate wrinkles, 4 = severe wrinkles). 20,21 If asymmetry was present, the investigator and subject rated the side with more severe wrinkles. Full contraction wrinkle values were used for the assessment of efficacy per the primary end point of the study.…”

“…20,21 Exclusion criteria included but were not limited to the use of blood-thinning agents, neuromuscular dysfunctions, previous cosmetic surgery, and visible scars in the treatment area. Subjects with a Fitzpatrick skin Type 5 or 6 were excluded because of the concerns for an increased risk of transient pigmentation changes.…”