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Abstract Details

Is the UPDRS a Reliable Tool for Detecting the Worse Side in Parkinson’s Disease?
Movement Disorders
P10 - Poster Session 10 (5:30 PM-6:30 PM)
3-017

To assess intra-rater and inter-rater agreement on the lateralizing components of the United Parkinson’s Disease Rating Scale (UPDRS) Motor Score (part III).   

 

The UPDRS is the most widely known tool for tracking Parkinson Disease (PD) progression. Part III lateralizing items include tremors (resting and action/posture), rigidity (neck, upper and lower limb) and bradykinesia (3 hand tasks and 1-foot task) with higher scores for worse performance on each side. 
Two movement disorder neurologists (JB & DB) performed UPDRS part III on the same 8 patients at 4 week intervals. The UPDRS was performed simultaneously but raters were blinded to each other and to past scores. An intra-class correlation coefficient (ICC) was calculated to estimate inter-rater reliability for total UPDRS scores. Cohen’s kappa was used to assess inter-rater agreement on lateralizing scores and intra-rater reliability across all visits. Worse side was defined as a difference of ≥ 3 between the total ratings or subcomponents for either side. 
There was almost perfect agreement between the two raters for total UPDRS scores across all visits (ICC=0.93, 95% CI=0.61-0.98). However, there was minimal agreement between raters on the total score of lateralizing components (kappa 0.37, CI 0.05-0.69). When analyzing subcomponent scores, there was a weak level of agreement on laterality of tremor (kappa 0.58, CI=0.17-0.99) and bradykinesia (kappa 0.41, CI=0.08-0.75) and no agreement on rigidity (kappa -0.05, CI=-0.13-0.02). Both raters had a moderate level of intra-rater agreement when determining the worse side on the same patient at different visits (JB 0.79, CI=0.41-1.00; DB 0.60, CI=0.11-1.00). 

When comparing UPDRS III scores between movement disorders neurologists there was perfect agreement on total score, but weak to minimal agreement on total or individual lateralizing subcomponents. It is unclear whether the UPDRS is reliable for detecting the side of worse symptoms in Parkinson's Disease patients.  

Authors/Disclosures
Erin Smith, MD (University of Nebraska Medical Center)
PRESENTER 		Dr. Smith has nothing to disclose.
John M. Bertoni, MD, PhD, FÂ鶹´«Ã½Ó³»­ (University of Nebraska Medical Center) Dr. Bertoni has nothing to disclose.
Danish Bhatti, MD, FÂ鶹´«Ã½Ó³»­ (University of Central Florida College of Medicine) Dr. Bhatti has nothing to disclose.
Diego Torres-Russotto, MD, FÂ鶹´«Ã½Ó³»­ (Miami Neuroscience Institute - Baptist Health South Florida) Dr. Torres-Russotto has received personal compensation for serving as an employee of Movement Disorders Consulting, Inc. The institution of Dr. Torres-Russotto has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AbbVie. The institution of Dr. Torres-Russotto has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurocrine. The institution of Dr. Torres-Russotto has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Revance. The institution of Dr. Torres-Russotto has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Anneal. Dr. Torres-Russotto has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for IPSEN. Dr. Torres-Russotto has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. The institution of Dr. Torres-Russotto has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie. The institution of Dr. Torres-Russotto has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Neurocrine. Dr. Torres-Russotto has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Your Nest Asset Solutions, LLC. Dr. Torres-Russotto has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Bright Future Asset Solutions, LLC.