Neurological Sciences

, Volume 34, Issue 11, pp 2015–2022 | Cite as

Adherence to anti-Parkinson drug therapy in the “REASON” sample of Italian patients with Parkinson’s disease: the linguistic validation of the Italian version of the “Morisky Medical Adherence scale-8 items”

  • G. Fabbrini
  • G. Abbruzzese
  • P. Barone
  • A. Antonini
  • M. Tinazzi
  • G. Castegnaro
  • S. Rizzoli
  • D. E. Morisky
  • P. Lessi
  • R. Ceravolo
  • On behalf of the REASON study group
Original Article


Information about patients’ adherence to therapy represents a primary issue in Parkinson’s disease (PD) management. To perform the linguistic validation of the Italian version of the self-rated 8-Item Morisky Medical Adherence Scale (MMAS-8) and to describe in a sample of Italian patients affected by PD the adherence to anti-Parkinson drug therapy and the association between adherence and some socio-demographic and clinical features. MMAS-8 was translated into Italian language by two independent Italian mother-tongue translators. The consensus version was then back-translated by an English mother-tongue translator. This translation process was followed by a consensus meeting between the authors of translation and investigators and then by two comprehension tests. The translated version of the MMAS-8 scale was then administered at the baseline visit of the “REASON” study (Italian Study on the Therapy Management in Parkinson’s disease: Motor, Non-Motor, Adherence and Quality Of Life Factors) in a large sample of PD patients. The final version of the MMAS-8 was easily understood. Mean ± SD MMAS-8 score was 6.1 ± 1.2. There were no differences in adherence to therapy in relationship to disease severity, gender, educational level or decision to change therapy. The Italian version of MMAS-8, the key tool of the REASON study to assess the adherence to therapy, has shown to be understandable to patients with PD. Patients enrolled in the REASON study showed medium therapy adherence.


Adherence Parkinson’s disease Validation Comprehension 



Anti-Parkinson drug


Hoehn and Yahr


4-Item Morisky Medical Adherence Scale


8-Item Morisky Medical Adherence Scale


Parkinson’s disease



The authors meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all aspects of manuscript development. We are grateful to MediData (Modena, Italy) for data collection and statistical analysis. This research was sponsored by a grant from Boehringer-Ingelheim.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Leopold NA, Polansky M, Hurka MR (2004) Drug adherence in Parkinson’s disease. Mov Disord 19:513–517PubMedCrossRefGoogle Scholar
  2. 2.
    Grosset D, European PD therapy compliance study group (2010) Therapy adherence issues in Parkinson’s disease. J Neurol Sci 289(1-2):115–118PubMedCrossRefGoogle Scholar
  3. 3.
    Grosset D, Antonini A, Canesi M, Pezzoli G, Lees A, Shaw K et al (2009) Adherence to antiparkinson medication in a multicenter European study. Mov Disord 24:826–832PubMedCrossRefGoogle Scholar
  4. 4.
    Valldeoriola F, Coronell C, Pont C, Buongiorno MT, Camara A, Gaig C, Compta Y, ADHESON Study Group (2011) Socio-demographic and clinical factors influencing the adherence to treatment in Parkinson’s disease: the ADHESON study. Eur J Neurol 18:980–987PubMedCrossRefGoogle Scholar
  5. 5.
    Tarrants ML, Denarié MF, Castelli-Haley J, Millard J, Zhang D (2010) Drug therapies for Parkinson’s disease: a database analysis of patient compliance and persistence. Am J Geriatr Pharmacother 8:374–383PubMedCrossRefGoogle Scholar
  6. 6.
    Kulkarni AS, Balkrishnan R, Anderson RT, Edin HM, Kirsch J, Stacy MA (2008) Medication adherence and associated outcomes in medicare health maintenance organization-enrolled older adults with Parkinson’s disease. Mov Disord 23:359–365PubMedCrossRefGoogle Scholar
  7. 7.
    Morisky DE, Malotte CK, Choi P et al (1990) A patient education program to improve adherence rate with antituberculosis drug regimens. Health Educ Q 17:253–268PubMedCrossRefGoogle Scholar
  8. 8.
    Morisky DE, DiMatteo MR (2011) Improving the measurement of self-reported medication nonadherence: final response. J Clin Epidemiol 64:258–263CrossRefGoogle Scholar
  9. 9.
    Elm JJ, Kamp C, Tilley BC, Guimaraes P, Fraser D, Deppen P, Brocht A, Weaver C, Bennett S, NINDS NET-PD Investigators and Coordinators (2007) Self-reported adherence versus pill count in Parkinson’s disease: the NET-PD experience. Mov Disord 22:822–827PubMedCrossRefGoogle Scholar
  10. 10.
    Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 10(5):348–354CrossRefGoogle Scholar
  11. 11.
    Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24:67–74PubMedCrossRefGoogle Scholar
  12. 12.
    Acquadro C, Joyce CRB, Patrick DL, Ware JE, Wu AW, Scientific Advisory Committee (2004) Linguistic validation manual for patient-reported outcomes (PRO) instruments. MAPI Research InstituteGoogle Scholar
  13. 13.
    Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56(1):33–39PubMedCrossRefGoogle Scholar
  14. 14.
    Tinazzi M, Abbruzzese G, Antonini A, Ceravolo R, Fabbrini G, Lessi P, Barone P Reasons driving to treatment modifications in Parkinson’s disease: the cross-sectional phase of the REASON study (submitted)Google Scholar
  15. 15.
    McDowell I, Newell C (1996) Measuring health: a guide to rating scales and questionnaires. Oxford University Press, New YorkGoogle Scholar
  16. 16.
    Measso GF, Cavarzeran F, Zappalà G et al (1993) The mini-mental state examination: normative study of a random sample of Italian population. Dev Neuropsychol 9:77–85CrossRefGoogle Scholar
  17. 17.
    Magni E, Binetti G, Bianchetti A, Rozzini R et al (1996) Mini-mental state examination: a normative study in Italian elderly population. Eur J Neurol 3:1–5CrossRefGoogle Scholar
  18. 18.
    Korb-Savoldelli V, Gillaizeau F, Pouchot J, Lenain E, Postel-Vinay N, Plouin PF, Durieux P, Sabatier B (2012) Validation of a French version of the 8-item Morisky medication adherence scale in hypertensive adults. J Clin Hypertens (Greenwich) 14:429–434CrossRefGoogle Scholar
  19. 19.
    Bailey GR, Barner JC, Weems JK, Leckbee G, Solis R, Montemayor D, Pope ND (2012) Assessing barriers to medication adherence in underserved patients with diabetes in Texas. Diabetes Educ 38:271–279PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • G. Fabbrini
    • 1
  • G. Abbruzzese
    • 2
  • P. Barone
    • 3
  • A. Antonini
    • 4
  • M. Tinazzi
    • 5
  • G. Castegnaro
    • 6
  • S. Rizzoli
    • 6
  • D. E. Morisky
    • 7
  • P. Lessi
    • 8
  • R. Ceravolo
    • 9
  • On behalf of the REASON study group
  1. 1.Sapienza University of Rome and IRCCS Neuromed InstitutePozzilli (IS)Italy
  2. 2.Neurosciences, Ophthalmology and Genetics DepartmentUniversity of GenovaGenoaItaly
  3. 3.Schola Medica SalernitanaUniversity of SalernoSalernoItaly
  4. 4.Department for Parkinson’s DiseaseIRCCS San CamilloVeniceItaly
  5. 5.Department of Neurological, Neuropsychological, Morphological and Movement SciencesUniversity of VeronaVeronaItaly
  6. 6.Medidata, Studi e RicercheModenaItaly
  7. 7.Department of Community Health SciencesUCLA Fielding School of Public HealthLos AngelesUSA
  8. 8.Boehringer-Ingelheim Italia S.p.A, Medical Clinical OperationMilanItaly
  9. 9.Neurosciences DepartmentUniversity of PisaPisaItaly

Personalised recommendations