Clinicians' tendencies to under-rate Parkinsonian tremors in the less affected hand

Hong Ji Lee, Sang Kyong Kim, Hyeyoung Park, Han Byul Kim, Hyo Seon Jeon, Yu Jin Jung, Eungseok Oh, Hee Jin Kim, Ji Young Yun, Beom S. Jeon, Kwang Suk Park

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8 Scopus citations


The standard assessment method for tremor severity in Parkinson's disease is visual observation by neurologists using clinical rating scales. This is, therefore, a subjective rating that is dependent on clinical expertise. The objective of this study was to report clinicians' tendencies to under-rate Parkinsonian tremors in the less affected hand. This was observed through objective tremor measurement with accelerometers. Tremor amplitudes were measured objectively using tri-axis-accelerometers for both hands simultaneously in 53 patients with Parkinson's disease during resting and postural tremors. The videotaped tremor was rated by neurologists using clinical rating scales. The tremor measured by accelerometer was compared with clinical ratings. Neurologists tended to under-rate the less affected hand in resting tremor when the contralateral hand had severe tremor in Session I. The participating neurologists corrected this tendency in Session II after being informed of it. The under-rating tendency was then repeated by other uninformed neurologists in Session III. Kappa statistics showed high inter-rater agreements and high agreements between estimated scores derived from the accelerometer signals and the mean Clinical Tremor Rating Scale evaluated in every session. Therefore, clinicians need to be aware of this under-rating tendency in visual inspection of the less affected hand in order to make accurate tremor severity assessments.

Original languageEnglish
Article number0131703
JournalPLoS ONE
Issue number6
StatePublished - 25 Jun 2015

Bibliographical note

Publisher Copyright:
© 2015 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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