We provide further validation of a Parkinson's disease (PD) home diary and explore implications for practical use in clinical trials. We previously developed and published a home PD diary that includes the categories ASLEEP, off, on without dyskinesia, on with nontroublesome dyskinesia, and on with troublesome dyskinesia [Hauser et al., J Clin Neuropharmacol 2000;23:75-81] and demonstrated that patients generally consider off time and on time with troublesome dyskinesia "bad time" and on time without dyskinesia or with nontroublesome dyskinesia "good time". We suggested that that on time without dyskinesia or with nontroublesome dyskinesia would be an appropriate outcome measure in clinical trials of advanced PD patients. In the current study, PD patients with motor fluctuations and dyskinesia (present more than 25% of the awake day and at least moderately disabling) completed daily diaries on 3 consecutive days in each of 2 consecutive weeks. In addition, patients provided responses to five questions regarding dyskinesia and their motor response through the day on visual analog scales (VAS). Three hundred two patients from 10 countries participated. Eighty-three percent (n = 252) completed six diaries without missing or duplicate entries. Seventy-six percent of the missing or duplicate entries occurred after Day 3. Mean percent of the awake day on without dyskinesia or with nontroublesome dyskinesia ("good on", ONG%) was observed to be very stable over time (repeated measure analysis of variance, P = 0.99). Coefficients of reliability as calculated by Cronbach's alpha were as follows: 2 days, r = 0.806; 3 days, r = 0.868; 4 days, r = 0.918; 5 days, r = 0.934; 6 days, r = 0.946. The standard error of measurement (SEM) was calculated to be 10.75%. VAS responses to the question, "How much of the day today did you experience a good response?" more strongly correlated with ONG% (0.41) than ON% (0.24). The diary appears to be sufficiently simple and feasible. Test-retest reliability was good, and reliability increased with increasing number of diary days but compliance diminished beyond 3 days. Good on time (ONG = on time without dyskinesia or with nontroublesome dyskinesia) most strongly correlated with patients' perceived duration of a good response through the day and is an important outcome variable.

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This paper attempts to summarize the measurement of craving with four different craving instruments and to relate this to definitions and measurement of relapse. The definitions of relapse may vary between studies and researchers, but are usually well defined. Five commonly used methods to measure relapse are: (1) quantity/frequency of drinking; (2) cumulative duration of abstinence (CDA); (3) post-withdrawal abstinent period; (4) stable recovery period; (5) the time line follow-back method. The definition of craving is much less clear and is mostly described as an emotional-motivational state or as obsessive-compulsive behaviour. Four self-rating instruments are briefly discussed and compared: the Obsessive-Compulsive Drinking Scale, OCDS, the Lübeck Craving Scale, LCRR, the Alcohol Craving Questionnaire, ACQ-Now-SF-R, and ordinal scales (e.g. visual analogue, Likert, or verbal descriptive scales). These instruments measure different aspects or dimensions of craving over different periods. The different dimensions measured suggest that there is still a need to conceptualize a standard interpretation of the word craving. There is a need also to measure an emotional-motivational dimension, a cognitive-behavioural dimension, expectancies, and effects on positive and negative reinforcement with different instruments or with one multidimensional instrument. It is suggested that different patients are expected to have different craving profiles.

The 14-item Obsessive Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument developed to measure cognitive aspects of craving for alcohol. The aim of this study was to translate the OCDS into Dutch (OCDS-Dutch). In addition, as a secondary exploratory exercise eight questions were added: three items referring to drinking intention, as potential substitutes for the OCDS items referring to drinking behavior, and five affective items. Three visual analogue scales were also added for comparison. The translated scale and the additional items were administered to 39 Dutch and Belgian alcohol-dependent patients. Translated and substituted scale scores were highly comparable with the OCDS. The internal consistency was good (alpha OCDS: 0.86, OCDS-Dutch: 0.85, and substituted scale: 0.89). The intercorrelations between scale and subscale scores ranged from 0.62 to 0.93 in all three versions of the scale. The relation with analogue craving measures of the OCDS-Dutch (r = 0.71) and substituted scale (r = 0.70) was higher than that of the OCDS (r = 0.40). The affective items did not improve reliability or validity of the scale in any way. The translated scale seems to be psychometrically as valid as the original scale. Substitution of the drinking behavior items by drinking intention items to predict alcohol use seems useful and further research with the proposed questions is suggested.

The Obsessive-Compulsive Drinking Scale (OCDS) is an instrument developed to measure cognitive aspects of alcohol craving. The aim of this study was to validate the French translation of the OCDS according to the international methodology as published by Hunt and coworkers (see text), including forward-backward translations, patient interviews (9 patients), patient’s perception of acceptability (15 patients), and final validation within a treatment program (50 patients). All 74 patients were native French-speaking alcohol-dependent patients from Belgium, France, and Switzerland. The derived aggregated total (TOT) score and both subscores corresponding to the obsessive (OB) and compulsive (CP) dimensions were shown to be asymptomatically normal. Good internal consistencies were found, with Cronbach α: TOT = 0.88; OB = 0.82; CP = 0.79. The test-retest procedure was used to examine intrarater reliability (r = 0.81). The construct validity was examined with linear correlation of the two main components: r(OB, CP) = 0.62; r(OB, TOT) = 0.86; r(CP, TOT) = 0.92. Principal-components analysis revealed two main factors: the first factor representing the total scale score, while the obsessive and compulsive subscale scores were distributed along factor two. The translated scale seems to be psychometrically as valid as the original English scale and confirms the psychometric properties of the OCDS.