Reliability Between In-Person and Still Photograph Assessment of Facial Function in Facial Paralysis Using the eFACE Facial Grading System
Ronit Malka, Matthew Q. Miller, Diego L. Guarín, Zoë Fullerton, Tessa A. Hadlock, Caroline A. Banks
Abstract
Importance: Assessing facial function using high-quality photographs would improve long-term and objective outcomes tracking in facial palsy, facilitate automated facial grading using artificial intelligence algorithms, and allow for remote follow up. Objective: To determine agreement between in-person and photographic electronic facial function scale (eFACE) assessments, and evaluate inter-rater reliability of photographic eFACE evaluation. Design, Setting, and Participants: Retrospective review of eFACE scores from in-person interviews and standardized photographs using the Massachusetts Eye and Ear (MEE) Standard Facial Palsy Dataset. Main Outcomes and Measures: eFACE total scores and subset scores determined by two experienced facial reanimation surgeons in person and from photographs. Results: Intraclass correlation coefficients for eFACE scores were 0.96 (95% CI 0.94 to 0.97) for total scores, 0.99 (95% CI 0.989 to 0.995) for static scores, 0.82 (95% CI 0.74 to 0.88) for dynamic scores, and 0.98 (95% CI 0.97 to 0.99) for synkinesis scores. Photographic and in-person scores had a mean difference of −0.64 (95% CI −2.05 to 0.77; p = 0.37) for total score, −1.58 (95% CI −4.22 to 1.05; p = 0.24) for the static subset, 0.14 (95% CI −1.70 to 1.97; p = 0.88) for the dynamic subset, and −1.11 (95% CI −3.09 to 0.86; p = 0.26) for the synkinetic subset. Bland-Altman analysis showed no trend for increasing differences in total score or subset scores. Conclusions: eFACE assessment obtained via photographs exhibits excellent inter-rater reliability and strong agreement with in-person assessment, demonstrating facial symmetry in facial palsy patients can be monitored using standardized frontal photographs.