Reliability and Validity of the Embouchure Dystonia Severity Rating Scale

Objective Embouchure dystonia (ED) is a task-specific movement disorder that leads to loss of fine motor control of the em-bouchure and tongue muscles in wind musicians. In contrast to musicians' hand dystonia, no validated severity rating for ED ex-ists, posing a major obstacle for structured assessment in scientific and clinical settings. The aim of this study is to validate an ED severity rating scale (EDSRS) allowing for a standardized estimation of symptom severity in ED. Methods The EDSRS was set up as a composite score of six items evaluating audio-visual disease symptoms during the perfor-mance of three standardized musical tasks (sustained notes, scales, and fourths) separately for each body side. For validation, 17 musicians with ED underwent standardized audiovisual recordings during performance. Anonymized and randomized recordings were assessed by two experts in ED (raters). Statistical analysis included metrics of consistency, reliability, and construct validity with the fluctuation of the fundamental frequency of the acoustic signal (F0) (extracted in an audio analysis of the sustained notes). Results The EDSRS showed high internal consistency (Cronbach's alpha = 0.975-0.983, corrected item-total correlations r = 0.90-0.96), interrater reliability (intraclass correlation coefficient [ICC] for agreement/consistency = 0.94/0.96), intrarater reliabil-ity over time (ICC per rater = 0.93/0.87) and good precision (standard error of measurement = 2.19/2.65), and correlated signifi-cantly with F0 variability (r = 0.55-0.60, p = 0.011-0.023). Conclusion The developed EDSRS is a valid and reliable tool for the assessment of ED severity in the hands of trained expert raters. Its easy applicability makes it suitable not only for routine clinical practice but also for scientific studies.

Automated summary

The study validates an ED severity rating scale (EDSRS) for standardized assessment of ED severity. The EDSRS showed high internal consistency, interrater reliability, intrarater reliability over time, and good precision. It also correlated significantly with F0 variability, indicating its validity as a tool for assessing ED severity.