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Original Investigation
December 22, 2016

Test-Retest Reliability and Agreement Between In-Person and Video Assessment of Facial Mimetic Function Using the eFACE Facial Grading System

Author Affiliations
  • 1Facial Nerve Center, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
JAMA Facial Plast Surg. Published online December 22, 2016. doi:10.1001/jamafacial.2016.1620
Key Points

Question  What is the test-retest reliability of the eFACE facial grading system, and do eFACE assessments made in person agree with those made using video?

Findings  This study demonstrated strong agreement between eFACE scores of facial function assessed in person and those assessed from video recordings. It also demonstrated high test-retest reliability of eFACE scores over time.

Meaning  The results of this study further validate the eFACE instrument as a high-resolution assessment of facial mimetic function and support its use in grading of facial outcomes using video documentation of mimetic facial function.


Importance  Use of a robust high-resolution instrument for grading of facial symmetry would enhance reporting the outcomes of facial reanimation interventions. The eFACE is one such tool.

Objective  To determine test-retest reliability of the eFACE tool over time and agreement between eFACE assessments made in person vs those made using video of facial mimetic function.

Design, Setting, and Participants  A prospective observational study was conducted among 75 consecutive patients with varying degrees of facial palsy who presented between July 1 and December 31, 2014, to an academic tertiary referral hospital. Facial symmetry of all patients was graded in person and via standardized photographic and video documentation of facial mimetic function at the initial visit. Three months after initial presentation, eFACE scores were reassessed by the same raters using the videos of facial mimetic function documented at the initial visit.

Main Outcomes and Measures  Individual and subset eFACE scores assessed by 2 facial reanimation surgeons.

Results  Among the 75 patients in the study (mean [SD] age, 48.18 [16.60] years; 30 men and 45 women), agreement between in-person and video assessments of facial function using the eFACE scale was excellent (static subset score: mean difference, 0.19; 95% CI, −1.51 to 1.88; P = .83; intraclass correlation coefficient [ICC], 0.85; 95% CI, 0.80 to 0.89; dynamic subset score: mean difference, −0.51; 95% CI, −1.72 to 0.71; P = .41; ICC, 0.96; 95% CI, 0.94 to 0.97; synkinesis subset score: mean difference, −1.14; 95% CI, −2.87 to 0.59; P = .20; ICC, 0.90; 95% CI, 0.86 to 0.93; and composite score: mean difference, −0.41; 95% CI, −1.30 to 0.47; P = .36; ICC, 0.94; 95% CI, 0.92 to 0.96). Agreement between repeated eFACE assessments of video of facial function was excellent (static subset score: ICC, 0.93; 95% CI, 0.87 to 0.96; dynamic subset score: ICC, 0.88; 95% CI, 0.80 to 0.94; synkinesis subset score: ICC, 0.92; 95% CI, 0.86 to 0.96; and composite score: ICC, 0.96; 95% CI, 0.93 to 0.98).

Conclusions and Relevance  Strong agreement exists between eFACE scores of facial function assessed in person and from video recordings. Test-retest reliability of eFACE scores is high. The eFACE is a reliable instrument for high-resolution assessment of facial mimetic function.

Level of Evidence  NA.