Unified Dyskinesia Rating Scale

Link to instrument: Link to UDRS

Acronym:

(UDysRS)

Purpose:

Purpose of the scale: (Goetz C et al, 2008, n = 70; mean age = 65.2 (8.9) years; mean duration of PD = 13.3 (8.5) years; HY stage (2-4) years)

Assess "On-Dyskinesia" ("choreic and dystonic movements explained to the patient as jerking or twisting movement that occurs when your medicine is working") and off- Dystonia ( explained to patient as "spasms or cramps that can be painful and occur when your Parkinson's disease medications are not taken or are not working") in individuals with treated Parkinson's disease (PD).

Description:

Description of the scale: (Goetz C et al, 2008) There are 2 sections: Historical and Objective. Historical section has Part 1 and 2, which are further subdivided into 1A,1B and 2A,2B.  Objective section has 2 subdivisions (parts 3 and 4) 

Part 1A: Is administered by the examiner. Examiner determines the total amount of time patient experiences "on dyskinesia" within past week and including the day of examination. The amount of time spent is then rated on a scale from 0-4.

• 0: Normal- No dyskinesia
• 1: Slight- < 25% of on-time
• 2: Mild- 26-50% of on-time
• 3: Moderate- 51-75% of on-time
• 4: Severe- > 75% of on-time

Part 1B: Is a patient or caregiver questionnaire with questions analyzing the impact of dyskinesia specifically over the past week on patients' activities of daily living such as speech, chewing and swallowing, eating tasks, dressing, hygiene, handwriting, doing hobbies and other activities, walking and balance, public and social settings, exciting or emotional settings. Impact of dyskinesia in each of this situation is assessed using 0-4 scale (0: Normal; 1:Slight; 2:Mild; 3:Moderate; 4:Severe)

Part 2A: Examiner asks question concerning the duration of time in a day patient experienced off dystonia within past week and including the day of examination. The duration is then rated on a scale from 0-4. (0 = Never 1 = Less than 30 minutes a day 2 = Less than 60 minutes a day 3 = Less than 2 hours a day 4 = Greater than 2 hours a day).

Part 2B: Is a patient or caregiver questionnaire and assesses the impact of off-period dystonia and pain associated with it on patient's daily activities. The impact is then scored on a scale of 0-4 (0: Normal, 1: Slight; 2: Mild; 3: Moderate and 4: Severe)

Objective section or Parts 3 & 4

Examiner observes patient directly or using videotape and rates the Intensity of the Impairment and the Disability associated with the patient's dyskinesia and dystonia during communication, drinking from a cup, dressing, and walking. The impairment ratings (intensity scale) is further assessed for each of the following seven body parts: Face, Neck, Arm/shoulder (right and left), Trunk, and Leg/hip (right and left)

ICF Domain: Body Structure, Body Function, Activity, Participation

Length of Test: 06 to 30 Minutes

Time to Administer:

15 minutes (Colosimo C et al, 2010)

Number of Items: 15 items under Historical Section: (Goetz C et al, 2008); Part 1 A (1 question); Part 1B (10 questions); Part 2A (1 question); Part 2B (3 questions); 11 items under Objective or Part 3

Equipment Required:

(Goetz C et al, 2008)

• Picture (Cookie Thief Drawing recommended)
• Cup filled with 4 oz water
• Lab coat
• Chair

Training Required:

Yes, A DVD-based teaching program is available which includes examples of patients in the form of videos which help in assessing the objective part of the scale and it also includes a certification exercise (Goetz C et al, 2009, n = 70; mean age = 65.2 (8.9) years; mean duration of PD = 13.3 (8.5) years; HY stage (2-4) years)

 

DVD available at: http://ift.tt/1VgEHF5

Type of training required: Reading an Article/Manual, Training Course

Actual Cost:

Unknown

Diagnosis: Geriatrics

Populations Tested:

• Parkinson's Disease

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Parkinson's Disease:

(Suppa et al 2011 {n = 20, 9 with dyskinesias (mean age 63 (6.8) years, mean UPDRS = 18 (7.3) on meds & UPDRS = 29 (8.8) off meds, mean disease duration = 9 (5.1), H&Y stage 1.5-3); and 11 without dyskinesias (mean age = 62 (8.1), mean UPDRS = 16 (4.6) on meds & UPDRS 26 (8.5) off meds, mean disease duration = 5 (3.7), H & Y 2-3)

• Clinical evaluation of peak dose dyskinesias in PD patients with levodopa induced dyskinesia. UDysRS scores ranged from 17-56, with mean score = 30 (12.8)

Test-retest Reliability:

Parkinson's Disease:

(Goetz C et al, 2011, n = 39; mean age = 63.7 (9.7) years; mean PD duration = 14.1(5.0) years)

• Excellent test-retest reliability (ICC = 0.822-0.513)

Interrater/Intrarater Reliability:

Parkinson's Disease:

(Goetz C et al, 2008; n = 70, H & Y stage 2-4, Range of dyskinesias (15 = no dyskinesia, 20 = mild, 20 = moderate, 15 = severe dyskinesias) )

• Excellent interrater reliability (ICC = 0.87) for impairment section
• Excellent interrater reliability (ICC = 0.91) for summary disability
• Excellent interrater reliability (ICC = 0.89) for total objective score
• Excellent intrarater reliability (ICC = 0.91) for impairment section
• Excellent intrarater reliability (ICC = 0.84) for summary disability
• Excellent intrarater reliability (ICC = 0.90) for total objective score
• Interrater reliability for impairment and disability items ranged from fair (kappa 0.4 to 0.59) to excellent (kappa > 0.8); with excellent total score reliability
• Intrarater reliability for impairment and disability items ranges from fair (kappa 0.59) to excellent (kappa > 0.8), with excellent total score reliability

Internal Consistency:

Parkinson's Disease:

(Goetz C et al, 2008)

• Excellent internal consistency (Cronbach's alpha > 0.92) or subjective and objective rating section.

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

Not Established

Content Validity:

Parkinson's Disease:

(Goetz et al, 2011; n = 39; mean age 63.7 years, mean duration of PD = 14.1 years)

• Temporal stability of UDysRS scores across an 8-hour observation period during clinical "on" and "off" states. Provides evidence that UDysRS is highly stable for individual patient's ON and OFF periods, thus is a reliable estimate of score

Face Validity:

Parkinson's Disease:

(Goetz C et al, 2008; n = 70, H & Y stage 2-4, Range of dyskinesias (15 = no dyskinesia, 20 = mild, 20 = moderate, 15 = severe dyskinesias)

• Scale developed by a team of 20 international movement disorder experts (Goetz, 2008)
• Excellent correlation between severity classification by the dyskinesia scale development team and patient self report (r = 0.81, p < 0.005)

Floor/Ceiling Effects:

Not Established

Responsiveness:

Parkinson's Disease:

(Goetz et al, 2013 (n = 61 with PD and dyskinesias, H & & stages 1-4, mean duration of disease = 9.0 (3.5) years)

• Able to detect significant treatment effects of Amantadine on dyskinesia, with Effect size = 0.138 (at 4 and 8 weeks compared to baseline scores); Better ability to measure change than a range of other dyskinesia rating scales and ADL rating scales

Considerations:

The test is developed by the researchers of the Movement Disorder Society. (Goetz C et al, 2008)

According to the Movement Disorder Society task force: (Colosimo C et al, 2010)

• Abnormal Involuntary Movement Scale and Rush Dyskinesia Rating scale are currently recommended scales to assess dyskinesia in Parkinson's disease.
• Although UDysRS has excellent reliability, it is a relatively new assessment tool and has not been used by other researchers outside the ones who developed the test, thus needing further research.
• Responsiveness testing to an intervention; convergent, discrimination and content validity have not been determined

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Bibliography:

Colosimo, C., Martinez-Martin, P., et al. (2010). "Task force report on scales to assess dyskinesia in Parkinson's disease: critique and recommendations." Movement Disorders 25(9): 1131-1142. Find it on PubMed

Goetz, C. G., Nutt, J. G., et al. (2008). "The Unified Dyskinesia Rating Scale: presentation and clinimetric profile." Movement Disorders 23(16): 2398-2403. Find it on PubMed

Goetz, C. G., Nutt, J. G., et al. (2009). "Teaching program for the Unified Dyskinesia Rating Scale." Movement Disorders 24(9): 1296-1298. Find it on PubMed

Goetz, C. G., Stebbins, G. T., et al. (2013). "Which Dyskinesia Scale Best Detects Treatment Response?" Movement Disorders.

Goetz, C. G., Stebbins, G. T., et al. (2011). "Temporal stability of the Unified Dyskinesia Rating Scale." Movement Disorders 26(14): 2556-2559. Find it on PubMed

Suppa, A., Marsili, L., et al. (2011). "Lack of LTP-like plasticity in primary motor cortex in Parkinson's disease." Experimental neurology 227(2): 296-301. Find it on PubMed

Instrument in PDF Format: Yes

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