Agreement between face-to-face and photograph and video assessments in children with Bell's palsy: secondary analysis of a randomised controlled trial

Abstract

OBJECTIVE: Bell's palsy is a sudden unilateral weakness of the facial muscles due to idiopathic lower motor neuron palsy of cranial nerve VII. We set out to determine the level of agreement in the severity of facial palsy based on the House-Brackmann scale between face-to-face assessment by clinicians, and independent clinician assessment of photographs and videos. DESIGN: Secondary analysis of children enrolled in a triple blind, randomised controlled trial assessing recovery rates following steroid treatment versus placebo for Bell's palsy who had photographs and videos recorded initially and at subsequent reviews. SETTING: 11 centres in Australia and New Zealand. PATIENTS: Children with Bell's palsy. INTERVENTIONS AND MAIN OUTCOME MEASURES: Standardised photographs and videos were independently reviewed for facial function using the House-Brackmann scale and compared with face-to-face assessment. RESULTS: A total of 175 participants had photos and videos of sufficient quality, with 399 separate assessments available. Mean age was 10 years and 51% were female. Intraclass correlation of House-Brackmann scores between face-to-face assessment and the photo and video reviewers for full recovery (House-Brackmann score=1) ranged from 0.67 to 0.76 at 1 month and 0.60 to 0.76 at 6 months. CONCLUSIONS: A comparison of facial function using the House-Brackmann scale between face-to-face clinician assessment and remote photography and video assessment by independent clinicians indicated a high level of agreement between the two assessments in terms of return to normal. Children may have their facial function assessed remotely in clinical and research settings if necessary. TRIAL REGISTRATION NUMBER: ACTRN1261500056356.