Skip to Content
International Parkinson and Movement Disorder Society

Revised Toronto Western Spasmodic Torticollis Rating Scale and Psychiatric Screening Tool (TWSTRS-2 & TWSTRS-PSYCH)

A simplified, efficient scale and a screening tool to evaluate psychiatric features associated with cervical dystonia.

Permission is required for each single use of the MDS Clinical Outcome Assessments. 

Request permission   View more assessments

The TWSTRS-2 is a revision of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) originally developed in the 1990s. The revision to address identified deficiencies was made by a committee of dystonia experts at a dystonia rating scales workshop organized by the Dystonia Medical Research Foundation. Following further validation testing, certain items were deleted, resulting in the final TWSTRS-2 as a simplified scale to be used efficiently in a clinical study. 

The TWSTRS-PSYCH was developed during the same workshop as a first of its kind screening tool to evaluate psychiatric features associated with cervical dystonia. The TWSTRS-PSYCH demonstrated good clinimetric properties.

The TWSTRS-2, TWSTRS-PSYCH, and the previously validated Cervical Dystonia Impact Profile (CDIP-58) were combined to produce the modular Comprehensive Cervical Dystonia Rating Scale (CCDRS), which measures motor severity, disability, pain, psychiatric disorders, and quality of life. The components can be used separately or together as a complete scale. The CDIP-58 is not managed by MDS.

Authors of TWSTRS-2: Cynthia L. Comella MD; Glenn T. Stebbins PhD; Kailash P. Bhatia FRCP; Susan H. Fox MRCP, PhD; William M. McDonald MD

Authors of TWSTRS-PSYCH: Mateusz Zurowski MD, MSc, FRCP; William M. McDonald MD; Laura Marsh MD; Cynthia L. Comella MD; Glenn T. Stebbins PhD; Hyder A. Jinnah MD, PhD

Original PublicationView the Scale (PDF) Permission required for use

  • Acronym: TWSTRS-2 and TWSTRS-PSYCH
  • Year Published: 2016
  • Scale Last Updated: No updates since publication
  • Assessment Type: ClinRO
  • Estimated Time to Complete: 15 minutes
  • Available Translations: None

  Eletronic builds: REDCap

To request permission to use this Rating Scale, please fill out a Permission Request Form.

Request Permission

 

 

Inclusive Language in Clinical Outcome Assessments

Healthcare providers should tailor the language used in COAs to reflect each patient’s gender identity. In grammatically gendered languages, the practice includes making appropriate linguistic adjustments to ensure communication is respectful and inclusive throughout the assessment process.

 

Browse all 30+ movement disorder assessments

View scales »