COSMIN database

Rating scales for musician's dystonia: the state of the art

Peterson, D. A., Berque, P., Jabusch, H. C., Altenmuller, E., and Frucht, S. J.
Musician's dystonia (MD) is a focal adult-onset dystonia most commonly involving the hand. It has much greater relative prevalence than non-musician's focal hand dystonias, exhibits task specificity at the level of specific musical passages, and is a particularly difficult form of dystonia to treat. For most MD patients, the diagnosis confirms the end of their music performance careers. Research on treatments and pathophysiology is contingent upon measures of motor function abnormalities. In this review, we comprehensively survey the literature to identify the rating scales used in MD and the distribution of their use. We also summarize the extent to which the scales have been evaluated for their clinical utility, including reliability, validity, sensitivity, specificity to MD, and practicality for a clinical setting. Out of 135 publications, almost half (62) included no quantitative measures of motor function. The remaining 73 studies used a variety of choices from among 10 major rating scales. Most used subjective scales involving either patient or clinician ratings. Only 25% (18) of the studies used objective scales. None of the scales has been completely and rigorously evaluated for clinical utility. Whether studies involved treatments or pathophysiologic assays, there was a heterogeneous choice of rating scales used with no clear standard. As a result, the collective interpretive value of those studies is limited because the results are confounded by measurement effects. We suggest that the development and widespread adoption of a new clinically useful rating scale is critical for accelerating basic and clinical research in MD.
1526-632X (Electronic)
Publication year:
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
5 - Videos
6 - Clinical rating scales
7 - Observations
9 - Laboratory tests
ADDS - Arm Dystonia Disability Scale
DDD - Dexterity and Displacement Device
DES - Dystonia Evaluation Scale
FAM - Frequency of Abnormal Movements scale
FM - Fahn-Marsden scale
GDS - Global Dystonia Rating Scale
MIDI-Based Scale Analysis - Musical Instrument Digital Interface-Based Scale Analysis
sdIOI - Standard Deviation of IOI interonset interval
TCS - Tubiana and Chamagne Scale
TRE - Test Repertoire Evaluation
UDRS - Unified Dystonia Rating Scale
VAS - Visual Analogue Scale