Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine

Abstract

Background Patients with facial nerve paralysis (FNP) experience challenges in accessing health care that could potentially be overcome by telemedicine. However, the reliability of telemedicine has yet to be established in this field. Objective This study aimed to investigate the consistency between face-to-face and video assessments of patients with FNP by experienced clinicians. Methods A repeated-measures design was used. A total of 7 clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardized grading systems (the House-Brackmann, Sydney, and Sunnybrook facial grading systems). After 3 months, the same grading systems were used to assess facial palsy in video recordings of the same patients. Results The House-Brackmann system in video assessment had excellent reliability and agreement (intraclass correlation coefficient [ICC]=0.780; principal component analysis [PCA]=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0%-95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), whereas that of other branches had good to excellent reliability and excellent agreement (ICC=0.625 to 0.862; PCA=85.7%-100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3%-100.0%) and synkinesis (ICC=−0.037 to 0.637; PCA=69.6%-87.0%) but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5%-91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within ±1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system. Conclusions Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement, especially in the assessment of synkinesis. However, video assessment does not account for the impact of real-time interactions that occur during tele-assessment sessions.

Navigating telemedicine for facial trauma during the COVID‐19 pandemic

“…The significant variation in agreement between the assessments done by video recording vs face to face evaluation may have been attributed to the 2D nature of the video recording. This study suggested that there is promise in utilizing video recordings for the assessment of FNP, but there is need for improvement and further testing using more real time images 27 …”

“…A repeated measures study by Tan et al 27 compared the reliability of telemedicine video evaluation of facial nerve paralysis (FNP) in 28 patients using the House‐Brackmann, Sydney, and Sunnybrook facial grading systems evaluated by 7 clinicians. All three scoring systems demonstrated strong reliability in both mediums, with weak reliability in assessment of synkinesis.…”

Raising the Digital Profile of Facial Palsy: National Surveys of Patients’ and Clinicians’ Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology

“…Asynchronous methods for monitoring FNP treatment outcomes have also recently been evaluated by 2 research teams. Tan et al [ 62 ] reported that the assessment of videos using the Sunnybrook and HB scales is as good as a face-to-face assessment, although the lack of real time interaction was judged to limit the value of this approach. Mothes et al [ 63 ] found that automatic Sunnybrook grading of photographs using machine learning can deliver fair agreement compared with the subjective rating of the same photographs.…”

e-Health and telemedicine implementation in facial paralysis: challenges and pitfalls

“…When the seventh cranial nerve (facial nerve, n. facialis, or NVII) is damaged, a form of facial nerve paralysis (FNP) could occur [ 6 ]. The facial nerve is responsible for the innervation of the mimic muscles, the secretomotor function of several glands (palatine, nasal, salivary, and lacrimal), and the gustatory organ [ 14 ].…”

“…Telemedicine is now used in several disciplines in plastic surgery like wound management, burn management, trauma, free-flap care, cleft/palate repair, hand surgery, and maxillofacial. In the field of FNP, there are several forms of telemedicine used, but the results are still varying [ 6 ]. Tan et al mentioned that in the specific field of FNP and telemedicine, there were not a lot of (large) studies conducted and most of the literature is on clinicians who implemented the techniques, without formal studies [ 6 ].…”