Validation of the clinician-graded electronic facial paralysis assessment: the eFACE.

Background: Facial paralysis remains a debilitating condition despite advances in medical, surgical and adjunctive interventions. Established grading systems used to assess facial paralysis and interventional outcomes have well described limitations. The Electronic Facial Paralysis Assessment (the eFACE), a clinician-graded zone-based facial function scale, has recently emerged as a grading tool that may provide greater sensitivity when assessing incomplete paralysis and post-surgical improvement. We perform the first comprehensive validation of the eFACE. Methods: Video recordings of eighty-three facial paralysis patients were assessed. Grading was performed in two sittings by three individuals with varying degrees of experience in assessing facial paralysis. Inter-observer reliability, intra-observer reliability, administration time, and agreement with the Facial Disability Index, House-Brackmann, Sunnybrook and Sydney facial grading systems were assessed. Results: eFACE scores demonstrated high intra-observer and inter-observer reliability (intraclass correlation coefficient 0.84-0.91and 0.81-0.83, respectively). The eFACE correlated well with the House-Brackmann, Sunnybrook and Sydney facial grading systems (Spearman rho 0.73, 0.77 and 0.77, respectively). In sub-domain analysis, the eFACE correlated well with the Sunnybrook and Sydney systems in dynamic movement (Spearman rho 0.90 and 0.89, respectively) and synkinesis (Spearman rho range 0.74 and 0.72, respectively). Agreement between the eFACE and the Facial Disability Index was poor (Spearman rho 0.25). The mean time to completion of the tool was 116+/-61 seconds. Conclusion: The eFACE is a valid facial assessment tool with high reliability and correlation with the established facial paralysis grading systems. It also provides an efficient and detailed analysis of paralysis according to each zone of the face. (C)2017American Society of Plastic Surgeons

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