{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:21:06Z","timestamp":1787898066065,"version":"build-2784847793"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["1R21 TR004422\u201001"],"award-info":[{"award-number":["1R21 TR004422\u201001"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["1R21 TR005231\u201001"],"award-info":[{"award-number":["1R21 TR005231\u201001"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["U54 TR001456"],"award-info":[{"award-number":["U54 TR001456"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016650","name":"Rare Diseases Clinical Research Network","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016650","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U54 NS065701"],"award-info":[{"award-number":["U54 NS065701"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U54 NS116025"],"award-info":[{"award-number":["U54 NS116025"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical dystonia (CD) motor severity is typically quantified with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). An expanded version of the Motor Severity section of the TWSTRS (\u201cTWSTRS\u2010Delphi\u201d) has been previously evaluated for its clinimetric properties but not for inter\u2010 and intrarater reliability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In this study we quantified inter\u2010 and intrarater reliability of the Motor Severity section of the TWSTRS\u2010Delphi for CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ten raters familiar with the TWSTRS\u2010Delphi and ten raters unfamiliar with it independently scored standardized videos from 90 patients with CD. We computed one\u2010way random intraclass correlation coefficient (ICC, absolute agreement) for total and item scores. We repeated assessments and calculations with a subset of raters to assess intrarater reliability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Interrater reliability for the Total score was good for Familiar raters (ICC\u2009=\u20090.697) and fair for Unfamiliar raters (ICC\u2009=\u20090.566). Most individual items achieved fair\u2013excellent interrater agreement in both groups (Familiar 0.415\u20130.763; Unfamiliar 0.416\u20130.769). Sagittal Shift, Duration, and Sensory Tricks showed poor agreement. Intrarater reliability was fair\u2013excellent for most items in both groups (Familiar 0.494\u20130.927; Unfamiliar 0.413\u20130.877), but poor for Sagittal Shift and Duration among Familiar raters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The TWSTRS\u2010Delphi yields reproducible Total and item scores across movement disorder raters. The data pinpoint Sagittal Shift, Duration, and Sensory Tricks as the principal sources of between\u2010rater variability, defining immediate priorities for scale modification and focused training.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70757","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:02:44Z","timestamp":1787896964000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interrater and Intrarater Reliability of the\n                    <scp>TWSTRS<\/scp>\n                    \u2010Delphi Motor Severity Scale for Cervical Dystonia"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7905-9336","authenticated-orcid":false,"given":"Glenn T.","family":"Stebbins","sequence":"first","affiliation":[{"name":"Department of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1045-2743","authenticated-orcid":false,"given":"Charles H.","family":"Adler","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic College of Medicine, Mayo Clinic Arizona  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5864-0006","authenticated-orcid":false,"given":"Alberto","family":"Albanese","sequence":"additional","affiliation":[{"name":"Department of Neurology IRCCS Mondino Neurological Research Hospital  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7858-9690","authenticated-orcid":false,"given":"Richard L.","family":"Barbano","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9663-095X","authenticated-orcid":false,"given":"Anna Rita","family":"Bentivoglio","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit\u2014Movement Disorders, University of Rome \u201cUniversit\u00e0 Cattolica del Sacro Cuore\u201d, Hospital of Rome \u201cAgostino Gemelli\u201d  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2216-3973","authenticated-orcid":false,"given":"Carlo","family":"Colosimo","sequence":"additional","affiliation":[{"name":"Department of Neurology LUM University, \u201cF. Miulli\u201d Regional Hospital  Acquaviva delle Fonti Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0312-184X","authenticated-orcid":false,"given":"Maria Fiorella","family":"Contarino","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Center  Leiden The Netherlands"},{"name":"Department of Neurology Haga Teaching Hospital  The Hague The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Dressler","sequence":"additional","affiliation":[{"name":"Movement Disorders Section, Department of Neurology Hannover Medical School  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0449-973X","authenticated-orcid":false,"given":"Stewart A.","family":"Factor","sequence":"additional","affiliation":[{"name":"Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7568-1645","authenticated-orcid":false,"given":"Susan H.","family":"Fox","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital  Toronto Ontario Canada"},{"name":"Department of Medicine, Division of Neurology University Health Network and the University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor S.C.","family":"Fung","sequence":"additional","affiliation":[{"name":"Sydney Medical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1665-8205","authenticated-orcid":false,"given":"Christopher G.","family":"Goetz","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4129-3674","authenticated-orcid":false,"given":"Joseph","family":"Jankovic","sequence":"additional","affiliation":[{"name":"Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology Baylor College of Medicine Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1531-3969","authenticated-orcid":false,"given":"Hyder A.","family":"Jinnah","sequence":"additional","affiliation":[{"name":"Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Department of Human Genetics Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8574-3297","authenticated-orcid":false,"given":"Wolfgang H.","family":"Jost","sequence":"additional","affiliation":[{"name":"Parkinson\u2010Klinik Ortenau  Wolfach Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5783-571X","authenticated-orcid":false,"given":"Marina A.J.","family":"Tijssen","sequence":"additional","affiliation":[{"name":"Department of Neurology University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7968-5908","authenticated-orcid":false,"given":"Elena","family":"Moro","sequence":"additional","affiliation":[{"name":"Grenoble Alpes University Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences  Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-8917","authenticated-orcid":false,"given":"Joel S.","family":"Perlmutter","sequence":"additional","affiliation":[{"name":"Department of Neurology Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Department of Radiology, Neuroscience, Physical Therapy, and Occupational Therapy Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen G.","family":"Reich","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon L.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Neurology One  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Severt","sequence":"additional","affiliation":[{"name":"AbbVie, Neuroscience  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natividad P.","family":"Stover","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Vidailhet","sequence":"additional","affiliation":[{"name":"Paris Brain Institute (ICM), Sorbonne University, Inserm U1227, CNRS  Paris France"},{"name":"Center of Excellence of Neurodegenerative Disease (CoEN), AP\u2010HP, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6800-3667","authenticated-orcid":false,"given":"Julianne","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute for Neural Computation, University of California, San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7100-4701","authenticated-orcid":false,"given":"Cynthia L.","family":"Comella","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-4078","authenticated-orcid":false,"given":"David A.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Institute for Neural Computation, University of California, San Diego  La Jolla California USA"},{"name":"Computational Neurobiology Laboratory, Salk Institute for Biological Studies  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"211","volume-title":"Therapy with Botulinum Toxin","author":"Consky ES","year":"1994"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1002\/mds.870120414","article-title":"Teaching tape for the motor section of the Toronto Western spasmodic torticollis scale","volume":"12","author":"Comella CL","year":"1997","journal-title":"Mov Disord"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","DOI":"10.3389\/dyst.2024.11309","article-title":"Tremor in cervical dystonia","volume":"3","author":"Beylergil SB","year":"2024","journal-title":"Dystonia"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1002\/mdc3.12131","article-title":"Development of the comprehensive cervical dystonia rating scale: methodology","volume":"2","author":"Comella CL","year":"2015","journal-title":"Mov Disord Clin Pract"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/mds.26534","article-title":"Clinimetric testing of the comprehensive cervical dystonia rating scale","volume":"31","author":"Comella CL","year":"2016","journal-title":"Mov Disord"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.660909","article-title":"The dystonia coalition: a multicenter network for clinical and translational studies","volume":"12","author":"Kilic\u2010Berkmen G","year":"2021","journal-title":"Front Neurol"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1002\/mds.10377","article-title":"Rating scales for dystonia: a multicenter assessment","volume":"18","author":"Comella CL","year":"2003","journal-title":"Mov Disord"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1037\/1082-989X.1.1.30","article-title":"Forming inferences about some intraclass correlation coefficients","volume":"1","author":"McGraw KO","year":"1996","journal-title":"Psychol Methods"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1037\/1040-3590.6.4.284","article-title":"Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology","volume":"6","author":"Cicchetti DV","year":"1994","journal-title":"Psychol Assess"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"3972","DOI":"10.1002\/sim.5466","article-title":"Sample size formulas for estimating intraclass correlation coefficients with precision and assurance","volume":"31","author":"Zou GY","year":"2012","journal-title":"Stat Med"},{"key":"e_1_2_10_12_1","first-page":"445","article-title":"The Toronto Western spasmodic torticollis rating scale (TWSTRS): assessment of validity and inter\u2010rater reliability","volume":"40","author":"Consky ES","year":"1990","journal-title":"Neurology"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.parkreldis.2012.02.007","article-title":"The Toronto Western spasmodic torticollis rating scale: reliability in neurologists and physiotherapists","volume":"18","author":"Boyce MJ","year":"2012","journal-title":"Parkinsonism Relat Disord"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1002\/mdc3.14222","article-title":"Interdisciplinary consensus in evaluating the severity subscale of the original and revised Toronto Western spasmodic torticollis rating scale through video\u2010based assessment: an inter\u2010rater reliability study","volume":"11","author":"Kassaye SG","year":"2024","journal-title":"Mov Disord Clin Pract."},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jns.2020.117205","article-title":"It's tricky: rating alleviating maneuvers in cervical dystonia","volume":"419","author":"Cisneros E","year":"2020","journal-title":"J Neurol Sci"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1212\/WNL.0000000000001341","article-title":"Is tremor in dystonia a phenotypic feature of dystonia?","volume":"84","author":"Defazio G","year":"2015","journal-title":"Neurology"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1002\/mds.28110","article-title":"Item response theory analysis of the MDS\u2010UPDRS motor examination: tremor vs. nontremor items","volume":"35","author":"Tosin MH d S","year":"2020","journal-title":"Mov Disord"},{"key":"e_1_2_10_18_1","first-page":"1","article-title":"A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: a review","volume":"12","author":"Bujang MA","year":"2017","journal-title":"Arch Orofac Sci"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1002\/mds.23096","article-title":"Teaching program for the movement disorder society\u2010sponsored revision of the unified Parkinson's disease rating scale: (MDS\u2010UPDRS)","volume":"25","author":"Goetz CG","year":"2010","journal-title":"Mov Disord"}],"container-title":["Movement Disorders Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mdc3.70757","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mdc3.70757","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mdc3.70757","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:02:47Z","timestamp":1787896967000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mdc3.70757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":18,"alternative-id":["10.1002\/mdc3.70757"],"URL":"https:\/\/doi.org\/10.1002\/mdc3.70757","archive":["Portico"],"relation":{},"ISSN":["2330-1619","2330-1619"],"issn-type":[{"value":"2330-1619","type":"print"},{"value":"2330-1619","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"assertion":[{"value":"2025-12-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"mdc3.70757"}}