Development and Validation of a Photonumeric Scale to Assess Marionette Lines
Nicola Kefalas, Sofía Ruiz del Cueto, Fernando Urdiales-Gálvez, Laurence Barry, Alessandro Gritti, Alexandre Marchac, Maria Lim, Carola de la Guardia, Graeme Kerson, Michael Silberberg- Dermatology
- General Medicine
- Surgery
BACKGROUND
A validated scale is needed for objective and reproducible comparisons of marionette lines before and after treatment in clinical studies.
OBJECTIVE
To describe the development and validation of a 5-point photonumeric marionette lines scale.
METHODS
The scale was developed to include an assessment guide, verbal descriptors, and real and morphed subject images for each scale grade. Intrarater and interrater reliability was evaluated in initial scale validation (web-based review) (
RESULTS
In the initial scale validation study, intrarater agreement for 2 physician raters was near perfect (weighted kappa = 0.92 and 0.94). Interrater agreement was excellent during sessions 1 and 2 (intraclass correlation coefficients of 0.94 and 0.95, respectively). In the live-subject validation study, intrarater agreement for 3 physician raters showed a strong correlation (mean weighted kappa = 0.77). Interrater agreement was high during live-subject validation sessions 1 and 2 (intraclass correlation coefficients = 0.89 for both sessions).
CONCLUSION
This new marionette lines scale is a validated and reliable scale for physician rating of marionette line severity.