{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T06:51:00Z","timestamp":1794466260290,"version":"4.9.1"},"posted":{"date-parts":[[2026,9,22]]},"group-title":"Neurology","reference-count":21,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"award":["U54 NS116025"],"award-info":[{"award-number":["U54 NS116025"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]},{"name":"United States Department of Veterans Affairs","award":["I01 RX003676"],"award-info":[{"award-number":["I01 RX003676"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tremor is a repetitive, oscillatory movement with multiple subtypes requiring accurate characterization for diagnosis and treatment. While frequency, amplitude, and context are routinely used to describe tremor, recent recommendations have emphasized oscillation shape and regularity. However, these descriptors lack strict operational definitions, and differences in how clinicians interpret them introduce inconsistency into tremor classification.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We quantified inter-rater reliability for commonly used tremor descriptors and determined which objectively measured signal parameters: peak amplitude, peak frequency, and frequency variability best explained inconsistency in rater assessments.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We developed the Tremor Waveform Morphology Questionnaire (TWMQ) and obtained standardized video recordings of 34 individuals with upper-extremity tremor performing rest, postural, and kinetic tasks, with simultaneous kinematic recordings using an inertial sensor. Movement disorder experts rated tremor presence, shape, symmetry, regularity, rhythmicity, and diagnosis. We assessed inter-rater reliability, cross-feature dependencies, and modeled the influence of objective signal parameters on each subjective rating.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Tremor presence and symmetry showed high agreement, whereas jerkiness, rhythmicity, amplitude stability, and clinical diagnosis showed lower reliability. Modeling revealed that peak amplitude primarily influenced judgments of tremor presence, jerkiness, and diagnosis, while frequency variability drove ratings of rhythmicity and amplitude stability.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Morphology-based descriptors remain subjective, but disagreement systematically reflects measurable signal properties. Objective definitions based on peak amplitude and frequency variability may improve the reliability and reproducibility of tremor characterization.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.21.26363551","type":"posted-content","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:15:30Z","timestamp":1790122530000},"source":"Crossref","is-referenced-by-count":1,"title":["Interrater reliability of Tremor Characterization"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1812-6691","authenticated-orcid":false,"given":"Prajakta","family":"Joshi","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuri Ferreira Felloni","family":"Borges","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Medicine, Amrita Institute of Medical Sciences, Faridabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Vidailhet","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France"},{"name":"Center of Excellence of Neurodegenerative Disease, Assistance Publique H\u00f4pitaux de Paris, Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Paris, France"},{"name":"Assistance Publique H\u00f4pitaux de Paris, Department of Neurology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Fung","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney School of Medicine, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hallett","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyder A.","family":"Jinnah","sequence":"additional","affiliation":[{"name":"Departments of Neurology, Pediatrics, and Human Genetics, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aasef G.","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA"},{"name":"Department of Neurology, Neurological Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA"},{"name":"Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Krembil Brain Institute, Toronto, Ontario, Canada"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026092501050829000_2026.09.21.26363551v1.1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1271312"},{"key":"2026092501050829000_2026.09.21.26363551v1.2","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2014.0225"},{"key":"2026092501050829000_2026.09.21.26363551v1.3","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000002350"},{"key":"2026092501050829000_2026.09.21.26363551v1.4","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awx104"},{"key":"2026092501050829000_2026.09.21.26363551v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2017.07.006"},{"key":"2026092501050829000_2026.09.21.26363551v1.6","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27121"},{"issue":"3","key":"2026092501050829000_2026.09.21.26363551v1.7","first-page":"180","article-title":"Tremor: Sorting Through the Differential Diagnosis","volume":"97","year":"2018","journal-title":"Am Fam physician"},{"key":"2026092501050829000_2026.09.21.26363551v1.8","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000210209"},{"key":"2026092501050829000_2026.09.21.26363551v1.9","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870130104"},{"key":"2026092501050829000_2026.09.21.26363551v1.10","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2009.089623"},{"key":"2026092501050829000_2026.09.21.26363551v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2022.01.004"},{"key":"2026092501050829000_2026.09.21.26363551v1.12","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.14010"},{"key":"2026092501050829000_2026.09.21.26363551v1.13","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.13150"},{"key":"2026092501050829000_2026.09.21.26363551v1.14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-61"},{"key":"2026092501050829000_2026.09.21.26363551v1.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2009.06.057"},{"key":"2026092501050829000_2026.09.21.26363551v1.16","doi-asserted-by":"publisher","DOI":"10.1007\/BF02344710"},{"key":"2026092501050829000_2026.09.21.26363551v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(71)90206-1"},{"key":"2026092501050829000_2026.09.21.26363551v1.18","doi-asserted-by":"publisher","DOI":"10.3390\/s100201399"},{"key":"2026092501050829000_2026.09.21.26363551v1.19","doi-asserted-by":"publisher","DOI":"10.3390\/electronics9101695"},{"key":"2026092501050829000_2026.09.21.26363551v1.20","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering10091025"},{"key":"2026092501050829000_2026.09.21.26363551v1.21","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.680011"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.21.26363551","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:05:14Z","timestamp":1790323514000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.21.26363551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":21,"URL":"https:\/\/doi.org\/10.64898\/2026.09.21.26363551","relation":{},"subject":[],"published":{"date-parts":[[2026,9,22]]},"subtype":"preprint"}}