{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:00:52Z","timestamp":1791198052865,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["01492947"],"award-info":[{"award-number":["01492947"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["91218013"],"award-info":[{"award-number":["91218013"]}],"id":[{"id":"10.13039\/501100001826","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>Reliable clinical phenotyping is crucial for diagnosis, treatment, and research in hyperkinetic movement disorders, yet its interrater reliability remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify interrater agreement in clinical phenotyping of hyperkinetic movement disorders among experts in a large, phenotypically diverse cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Within the NEMO project, 161 patients with hyperkinetic movement disorders underwent standardized video assessments. Each patient was independently classified by three international movement disorders experts in a structured, stepwise procedure. Experts first assessed videos alone, then received clinical history and examination, and finally diagnostic test results. At each step, they assigned primary and secondary phenotypes and rated their diagnostic confidence. Interrater agreement was assessed using Fleiss\u2019 and Cohen's kappa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across all phenotypes, interrater agreement on the primary phenotype increased with added information (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.457 to\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.607). Agreement with the NEMO reference classification similarly improved (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.478 to\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.656). Among patients with a single dominant phenotype, agreement reached\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.78. In 93% of cases, at least two out of three experts reached consensus. Agreement was substantially lower in patients with mixed or complex presentations, such as myoclonus\u2010dystonia and functional movement disorders. Diagnostic certainty rose throughout, though secondary phenotype agreement remained poor. Experts rarely revised initial impressions, suggesting robust pattern recognition but also potential confirmation bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Movement disorders specialists can reliably identify hyperkinetic phenotypes, even without in\u2010person assessment. While complex, mixed and functional presentations remain diagnostically challenging, our findings reinforce the value of expert phenotyping in clinical care, training, and research, and provide a benchmark for future studies and computational approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70808","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:14:45Z","timestamp":1791195285000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Defining the Clinical Phenotypic Ground Truth: Expert Interrater Agreement in Hyperkinetic Movement Disorders"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-2019","authenticated-orcid":false,"given":"Madelein","family":"van der Stouwe","sequence":"first","affiliation":[{"name":"Expertise Center Movement Disorders Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Neurology University Medical Center Groningen, University of Groningen  Groningen the Netherlands"},{"name":"Department of Neurology Ommelander Ziekenhuis Groningen  Scheemda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Expertise Center Movement Disorders Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Neurology University Medical Center Groningen, University of Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7006-1672","authenticated-orcid":false,"given":"Wieke","family":"Eggink","sequence":"additional","affiliation":[{"name":"Expertise Center Movement Disorders Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Neurology University Medical Center Groningen, University of Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tove","family":"Henriksen","sequence":"additional","affiliation":[{"name":"Movement Disorder Clinic University Hospital of Bispebjerg  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7325-8959","authenticated-orcid":false,"given":"Eavan","family":"McGovern","sequence":"additional","affiliation":[{"name":"Department of Neurology Beaumont Hospital  Dublin Ireland"},{"name":"School of Medicine Royal College of Surgeons in Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marenka","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical Clinic Velsen  Velsen\u2010Noord the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7877-6760","authenticated-orcid":false,"given":"Selma","family":"Aybek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Science and Medicine University of Fribourg  Fribourg Switzerland"},{"name":"Psychosomatic Medicine Unit, Department of Neurology Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnita","family":"Boon","sequence":"additional","affiliation":[{"name":"Department of Neurology Erasmus MC Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Brandsma","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5527-0196","authenticated-orcid":false,"given":"Andres","family":"Deik","sequence":"additional","affiliation":[{"name":"Parkinson's Disease and Movement Disorders Center University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7800-7419","authenticated-orcid":false,"given":"Roberto","family":"Erro","sequence":"additional","affiliation":[{"name":"Department of Medicine Surgery and Dentistry \u201cScuola Medica Salernitana,\u201d University of Salerno  Fisciano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-136X","authenticated-orcid":false,"given":"Alberto","family":"Espay","sequence":"additional","affiliation":[{"name":"James J. and Joan A. 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