The Movement Disorder Society-UPDRS (MDS-UPDRS) was published in 2008, showing satisfactory clinimetric results and has been proposed as the official benchmark scale for Parkinson’s disease. The present study, based on the official MDS-UPDRS Spanish version, performed the first independent testing of the scale and adds information on its clinimetric properties. The cross-culturally adapted MDS-UPDRS Spanish version showed a comparative fit index ≥0.90 for each part (I–IV) relative to the English-language version and was accepted as the Official MDS-UPDRS Spanish version. Data from this scale, applied with other assessments to Spanish-speaking Parkinson’s disease patients in five countries, were analyzed for an independent and complementary clinimetric evaluation. In total, 435 patients were included. Missing data were negligible and moderate floor effect (30 %) was found for Part IV. Cronbach’s α index ranged between 0.79 and 0.93 and only five items did not reach the 0.30 threshold value of item-total correlation. Test–retest reliability was adequate with only two sub-scores of the item 3.17, Rest tremor amplitude, reaching κ values lower than 0.60. The intraclass correlation coefficient was higher than 0.85 for the total score of each part. Correlation of the MDS-UPDRS parts with other measures for related constructs was high (≥0.60) and the standard error of measurement lower than one-third baseline standard deviation for all subscales. Results confirm those of the original study and add information on scale reliability, construct validity, and precision. The MDS-UPDRS Spanish version shows satisfactory clinimetric characteristics.
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Chaudhuri KR, Healy D, Schapira AHV (2006) The non-motor symptoms of Parkinson’s disease. Diagnosis and management. Lancet Neurol 5:235–245. doi:10.1016/S1474-4422(06)70373-8
Fahn S, Elton RL, Members of the UPDRS Development Committee (1987) Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent developments in Parkinson’s disease, vol 2. Macmillan Healthcare Information, Florham Park, pp 153–164
Movement Disorder Society Task Force on Rating Scales for Parkinson’s Disease (2003) The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations. Mov Disord 18:738–750. doi:10.1002/mds.10473
Goetz CG, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stebbins GT et al (2007) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format and clinimetric testing plan. Mov Disord 22:41–47. doi:10.1002/mds.21198
Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P et al (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170. doi:10.1002/mds.22340
Nunnally JC, Bernstein IH (1994) Psychometric theory. McGraw-Hill, New York
Gibb WRG, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752. doi:10.1136/jnnp.51.6.745
Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression, and mortality. Neurology 17:427–442. doi:10.1212/WNL.17.5.427
Martínez Martín P (2004) Valoración de la deficiencia y discapacidad en la enfermedad de Parkinson. In: Grandas F, Obeso JA, Tolosa E (eds) Tratado sobre la Enfermedad de Parkinson, 3ª Edición. Madrid: Luzán 5 S.A., pp 289–319
Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P et al (2007) The metric properties of a novel non-motor symptoms scale for Parkinson’s disease: results from an international pilot study. Mov Disord 22:1901–1911. doi:10.1002/mds.21596
Martinez-Martin P, Rodriguez-Blazquez C, Abe K, Bhattacharyya KB, Bloem BR, Carod-Artal FJ et al (2009) International study on the psychometric attributes of the Non-Motor Symptoms Scale in Parkinson disease. Neurology 73:1584–1591. doi:10.1212/WNL.0b013e3181c0d416
Martinez-Martin P, Forjaz MJ, Cubo E, Frades B, de Pedro Cuesta J, ELEP Project Members (2006) Global versus factor-related impression of severity in Parkinson’s disease: a new clinimetric index (CISI-PD). Mov Disord 21:208–214. doi:10.1002/mds.20697
Martínez-Martín P, Rodríguez-Blázquez C, Forjaz MJ, de Pedro J, On behalf of the Spanish-American Longitudinal PD Patient Study Group (2009) The Clinical Impression of Severity Index for Parkinson’s disease: International Validation Study. Mov Disord 24:211–217. doi:10.1002/mds.22320
EuroQol Group (1990) EuroQol-a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16:199–208. doi:10.1016/0168-8510(90)90421-9
Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N (1997) The PDQ-8: development and validation of a short-form Parkinson’s disease Questionnaire. Psychol Health 12:805–814. doi:10.1080/08870449708406741
Goetz CG, Poewe W, Rascol O et al (2004) Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 19:1020–1028. doi:10.1002/mds.20213
Martínez-Martín P, Forjaz MJ, Frades B, Cubo E, de Pedro J (2005) La Rapid Assessment Disability Scale (RAD) en Enfermedad de Parkinson. Gac Sanit 19(Suppl 1):68
Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ (2004) Improving the evaluation of therapeutic interventions in multiple sclerosis: development of a patient-based measure of outcome. Health Technol Assess 8(9):21. doi:10.3310/hta8090
Shrive FM, Stuart H, Quan H, Ghali WA (2006) Dealing with missing data in a multi-question depression scale: a comparison of imputation methods. BMC Med Res Methodol 6:57. doi:10.1186/1471-2288-6-57
McHorney CA, Tarlov AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4:293–307. doi:10.1007/BF01593882
Hays RD, Anderson R, Revicki D (1993) Psychometric considerations in evaluating health-related quality of life measures. Qual Life Res 6:441–449. doi:10.1007/BF00422218
Scientific Advisory Committee of the Medical Outcomes Trust (2002) Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11:193–205. doi:10.1023/A:1015291021312
Eisen M, Ware JE Jr, Donald CA, Brook RH (1979) Measuring components of children’s health status. Med Care 17:902–921
Fitzpatrick R, Davey C, Buxton MJ, Jones DR (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assessm 2(14):19–43. doi:10.3310/hta2140
Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A (2001) The Multiple Sclerosis Impact Scale (MSIS-29). A new patient-based outcome measure. Brain 124:962–973. doi:10.1093/brain/124.5.962
Fayers PM, Machin D (2000) Quality of Life. Assessment, analysis and interpretation. Wiley, Chichester, pp 45–71
Wyrwich KW, Bullinger M, Aaronson N, Hays RD, Patrick DL, Symonds T, The Clinical Significance Consensus Meeting Group (2005) Estimating clinically significant differences in quality of life outcomes. Qual Life Res 14:285–295. doi:10.1007/s11136-004-0705-2
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22. doi:10.1186/1471-2288-10-22
Martínez-Martín P, Forjaz MJ (2006) Metric attributes of the UPDRS 3.0 battery. Part I: feasibility, scaling assumptions, reliability, and precision. Mov Disord 21:1182–1188. doi:10.1002/mds.20916
Martinez-Martin P, Gil-Nagel A, Morlán Gracia L, Balseiro Gómez J, Martinez Sarriés J, Bermejo F et al (1994) Unified Parkinson’s Disease Rating Scale characteristics and structure. Mov Disord 9:76–83. doi:10.1002/mds.870090112
Marinus J, Visser M, Stiggelbout AM, Martin Rabey J, Martinez-Martin P, Bonuccelli U et al (2004) A short scale for the assessment of motor impairments and disabilities in Parkinson’s disease: the SPES/SCOPA. J Neurol Neurosurg Psychiatry 75:388–395. doi:10.1136/jnnp.2003.017509
Siderowf A, McDermott M, Kieburtz K, Blindauer K, Plumb S, Shoulson I et al (2002) Test-retest reliability of the Unified Parkinson’s Disease Rating Scale in patients with early Parkinson’s disease: results from a multicenter clinical trial. Mov Disord 17:758–763. doi:10.1002/mds.10011
Gallagher DA, Goetz CG, Stebbins G, Lees AJ, Schrag A (2012) Validation of the MDS-UPDRS Part I for nonmotor symptoms in Parkinson’s disease. Mov Disord 27:79–83. doi:10.1002/mds.23939
Forjaz MJ, Martinez-Martin P (2006) Metric attributes of the UPDRS 3.0 battery. Part II: construct and content validity. Mov Disord 21:1892–1898. doi:10.1002/mds.21071
Terwee CB, Roorda LD, Knol DL, De Boer MR, De Vet HCW (2009) Linking measurement error to minimal important change of patient-reported outcomes. J Clin Epidemiol 62:1062–1067. doi:10.1016/j.jclinepi.2008.10.011
Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek AL (2001) Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res 10:571–578. doi:10.1023/A:1013138911638
Rejas J, Pardo A, Ruiz MA (2008) Standard error of measurement as a valid alternative to minimally important difference for evaluating the magnitude of changes in patient-reported outcomes measures. J Clin Epidemiol 61:350–356. doi:10.1016/j.jclinepi.2007.05.011
Grove A, Amante PG, Quarterman P, Wild D (2000) The translation and cross-cultural adaptation of quality-of-life measures. In: Jenkinson C, Fitzpatrick R, Jenkinson D (eds) Health status measurement in neurological disorders. Radcliffe Medical Press, Oxon, pp 161–190
Masur H (2004) Scales and scores in neurology. Thieme, Stuttgart, pp 4–51
McDowell I (2006) Measuring health. A guide to rating scales and questionnaires, 3rd edn. Oxford University Press, Oxford, pp 3–54
The funds for this study were provided by the Movement Disorder Society that received partial support from UCB Spain.
Conflicts of interest
The authors declare that they have no conflict of interest.
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Martinez-Martin, P., Rodriguez-Blazquez, C., Alvarez-Sanchez, M. et al. Expanded and independent validation of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). J Neurol 260, 228–236 (2013). https://doi.org/10.1007/s00415-012-6624-1
- Parkinson’s disease
- Rating scales