Potential reliability and validity of a modified version of the Unified Parkinson's Disease Rating Scale that could be administered remotely

Abstract

Background By permitting remote assessments of patients and research participants, telemedicine has the potential to reshape clinical care and clinical trials for Parkinson disease. While the majority of the motor Unified Parkinson’s Disease Rating Scale (UPDRS) items can be conducted visually, rigidity and retropulsion pull testing require hands-on assessment by the rater and are less feasible to perform remotely in patients' homes. Methods In a secondary data analysis of the Comparison of the Agonist pramipexole vs. Levodopa on Motor complications in Parkinson’s Disease (CALM-PD) study, a randomized clinical trial, we assessed the cross-sectional (baseline and 2 years) and longitudinal (change from baseline to 2 years) reliability of a modified motor UPDRS (removing rigidity and retropulsion items) compared to the standard motor UPDRS (all items) using intraclass correlation coefficients (ICC), stratified by treatment group. Internal consistency of the modified UPDRS (mUPDRS) was measured using Cronbach’s alpha, and concurrent validity was assessed using Pearson’s correlation coefficient (r) between the standard motor UPDRS and mUPDRS. Results The mUPDRS versus standard motor UPDRS is cross-sectionally (ICC ≥ 0.92) and longitudinally (ICC ≥ 0.92) reliable for both treatment groups. High internal consistencies were also observed (α ≥ 0.96). The mUPDRS had high concurrent validity with the standard UPDRS at both time points and longitudinally (r ≥ 0.93, p < 0.0001). Conclusions A modified version of the motor UPDRS without rigidity and retropulsion pull testing is reliable and valid and may lay the foundation for its use in remote assessments of patients and research participants.

Telemedicine in Parkinson's disease: A patient perspective at a tertiary care centre

“…Evidence from the literature, however, suggests that a modified version of UPDRS-III without rigidity and retropulsion pull testing administered remotely was reliable and valid [3,4]. This suggests that education regarding the effectiveness of PD assessment via telehealth could help remove barriers to its adoption by allaying patient fears and increasing confidence in the telemedicine program.…”

“…Several studies have shown that assessment of motor impairment in PD via telehealth is feasible, valid, and reliable [3,4]. Randomized clinical trials (RCTs) have shown that telemedicine programs for PD care could be feasible, cost-effective, and provide clinical benefit equivalent to that of traditional in-person care [5,6].…”

National randomized controlled trial of virtual house calls for Parkinson disease

“…The motor portion (part III) of the scale was modified to exclude assessments of rigidity and balance, which cannot be assessed remotely. 23 Additional assessments included changes in the 15-item Geriatric Depression Scale, the Montreal Cognitive Assessment, the European Quality of Life Five Dimension Five Level Scale, and the Patient Global Impression of Change. Patient and clinician satisfaction, as well as hospitalizations and emergency department visits, were evaluated by survey after each visit.…”

Remotely Assessing Symptoms of Parkinson’s Disease Using Videoconferencing: A Feasibility Study

“…With timely monitoring, many of these adverse effects are reversible through reduction or cessation of medication [7]. As PD progresses, loss of mobility can cause clients to become bedridden or confined to a wheelchair, increasing the difficulty of travelling to medical appointments [8]. …”

“…Abdolahi et al (2013) conducted a study to compare whether administering the UPDRS without the items that require physical interaction would make a significant difference to trial outcomes [8]. Modified UPDRS scores, which exclude the rigidity and postural stability testing items, were compared to the standard UPDRS [8].…”