Video-Based Pairwise Comparison: Enabling the Development of Automated Rating of Motor Dysfunction in Multiple Sclerosis.

Burggraaff, Jessica; Dorn, Jonas; D'Souza, Marcus; Morrison, Cecily; Kamm, Christian P.; Kontschieder, Peter; Tewarie, Prejaas; Steinheimer, Saskia; Sellen, Abigail; Dahlke, Frank; Kappos, Ludwig; Uitdehaag, Bernard (2020). Video-Based Pairwise Comparison: Enabling the Development of Automated Rating of Motor Dysfunction in Multiple Sclerosis. Archives of physical medicine and rehabilitation, 101(2), pp. 234-241. Elsevier 10.1016/j.apmr.2019.07.016

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OBJECTIVES To examine the feasibility, reliability, granularity, and convergent validity of a video-based pairwise comparison technique that uses algorithmic support to enable automated rating of motor dysfunction in patients with multiple sclerosis (MS). DESIGN Feasibility and larger cross-sectional cohort study. SETTING The outpatient clinic of 2 specialist university medical centers. PARTICIPANTS Selected sample from a cohort of patients with MS participating in the Assess MS study (N=42). Videos were randomly drawn from each strata of the ataxia severity-degrees as defined in the Expanded Disability Status Scale (EDSS). In Basel: 19 videos of 17 patients (mean age, 43.4±11.6y; 10 women). In Amsterdam: 50 videos of 25 patients (mean age, 50.0±10.0y; 15 women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES In each center, neurologists (n=13; n=10) viewed pairs of videos of patients performing standardized movements (eg, finger-to-nose test) to assess relative performance. A comparative assessment score was calculated for each video using the TrueSkill algorithm and analyzed for intrarater (test-retest; ratio of agreement) and interrater reliability (intraclass correlation coefficient [ICC] for absolute agreement) and convergent validity (Spearman ρ). Granularity was estimated from the average difference in comparative assessment scores at which 80% of neurologists considered performance to be different. RESULTS Intrarater reliability was excellent (median ratio of agreement≥0.87). The comparative assessment scores calculated from individual neurologists demonstrated good-excellent ICCs for interrater reliability (0.89; 0.71). The comparative assessment scores correlated (very) highly with their Neurostatus-EDSS equivalent (ρ=0.78, P<.001; ρ=0.91, P<.05), suggesting a more fine-grained rating. CONCLUSIONS Video-based pairwise comparison of motor dysfunction allows for reliable and fine-grained capturing of clinical judgment about neurologic performance, which can contribute to the development of a consistent quantified metric of motor ability in MS.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kamm, Christian Philipp and Steinheimer, Saskia Marie


600 Technology > 610 Medicine & health








Chantal Kottler

Date Deposited:

19 Dec 2019 11:11

Last Modified:

29 Jan 2020 01:33

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Matched-pair analysis Motor disorders Multiple sclerosis Outcome measures Patient outcome assessment Rehabilitation




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