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European Journal of Physical and Rehabilitation Medicine 2021 Jun 09

DOI: 10.23736/S1973-9087.21.06629-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Sunnybrook Facial Grading System reliability in subacute stroke patients

Marco TRAMONTANO 1 , Giovanni MORONE 1, Federica M. LA GRECA 1, Valeria MARCHEGIANI 1, Angela PALOMBA 2, Marco IOSA 3, 1, Giulia MUSTO 1, Marilia SIMONELLI 1

1 IRCCS Fondazione Santa Lucia, Rome, Italy; 2 Multidisciplinary Department of Medicine for Surgery and Orthodontics, University of Campania Luigi Vanvitelli, Naples, Italy; 3 Department of Psychology, Sapienza University of Rome, Rome, Italy


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BACKGROUND: A lack of evidence on the reliability limits the utility of the Sunnybrook Facial Grading System (SFGS) in individuals affected by stroke both in clinical and research settings.
AIM: To examine the test-retest reliability and the inter-rater reliability of the SFGS in patients affected by subacute stroke.
DESIGN: A repeated-assessments design (fifteen days apart) was used to examine the test-retest reliability of the SFGS.
SETTING: Inpatient rehabilitation unit.
POPULATION: Thirty-two inpatients with subacute stroke.
METHODS: Thirty-two inpatients with subacute stroke participated in the test-retest reliability study. All patients were video-recorded in sitting position and uncovered face for about two minutes, in static position to evaluate symmetry at rest, then assessing symmetry of voluntary movement and synkinesis. For the inter-rater reliability, fifteen experts in neurorehabilitation were selected as raters. The facial function was assessed using the Italian version of the SFGS was used as grading system on a recorded video of each patient. The inter-rater reliability was carried out through the ICC, Intraclass Correlation Coefficient, while the intra-rater reliability was assessed comparing for each rater the scores evaluated at T0 and T1 using Wilcoxon signed-rank test.
RESULTS: Evaluations at T0 and T1 showed a significant correlation with a total ICC (T0 + T1) of 0.901 (95% CI 0.852-0.942; p-value <0.001). The ICC of T0 scores is 0.914 (95% CI 0.869-0.950; p-value <0.001), while the ICC of T1 scores is 0.886 (95% CI 0.829-0.995; p-value <0.001). The scores of the "voluntary movement symmetry" area are correlated with ICC of 0.916 (95% CI 0.835-0.958; p-value <0.001). The scores of the "resting symmetry" area show correlation with ICC of 0.567 (95% CI 0.277-0.762; p-value <0.001). The area of "synkinesis" shows a lower correlation with ICC of 0.175 (95% CI -0.180-0.489; p-value <0.001). The scores attributed to the patients in the two different moments of observation resulted not significantly different from 12 out of 15 raters.
CONCLUSIONS: The SFGS resulted reliable in its overall score to assess the facial palsy also in patients affected by stroke.
CLINICAL REHABILITATION IMPACT: The findings of this study provide empirical evidence of reliable properties of the SFGS for assessing central facial palsy in patients with stroke.


KEY WORDS: Sunnybrook; Stroke; Facial palsy; Rehabilitation; Reliability; Psychometrics

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