Review article
Evaluation of Measures of Upper Limb Functioning and Disability in People With Parkinson Disease: A Systematic Review

Preliminary results presented as a poster to the World Parkinson Congress, October 1-4, 2013, Montreal, Quebec, Canada.
https://doi.org/10.1016/j.apmr.2014.09.016Get rights and content

Highlights

  • We identified tools used for upper limb evaluation in Parkinson disease.

  • We examined studies of their measurement properties in this clinical group.

  • Evidence of the reliability of these measures in this population is limited.

  • No high-quality investigations of validity or responsiveness were identified.

  • Further investigation of these properties would inform clinical practice.

Abstract

Objectives

To identify measurement tools used for upper limb evaluation in people with Parkinson disease (PD), to summarize the content of each tool using the International Classification of Functioning, Disability and Health, and to examine the reliability, validity, clinical utility, and responsiveness of the measurement tools specific to this clinical group.

Data Sources

Two systematic searches of online databases included articles published from inception to November 2013.

Study Selection

Search 1 identified upper limb measures. Search 2 retrieved studies investigating the measurement properties of these tools in people with PD.

Data Extraction

Independent reviewers screened articles and extracted data, classified measurement tool content on the basis of the International Classification of Functioning, Disability and Health content domains, and applied both the COnsensus-based Standards for the selection of health status Measurement INstruments checklist to evaluate the study's methodological quality and a second checklist by Terwee et al to assess the measurement tool's quality. A third reviewer adjudicated differences between reviewers. Information on clinical utility was also compiled.

Data Synthesis

The 18 identified measures included PD-specific scales, generic measures, and tools developed for other clinical populations; most measures evaluated impairments and/or activity limitations. Measurement properties of 10 of the 18 identified measures were evaluated in people with PD. No high-quality studies investigated validity or responsiveness. High-quality evidence supported the interrater reliability of some Unified Parkinson's Disease Rating Scale subtests, and lower quality studies provided limited evidence for the test-retest reliability of measures evaluating fine hand function and bradykinesia.

Conclusions

There are relatively few high-quality studies to support the measurement properties, particularly the validity and responsiveness, of tools currently used to evaluate upper limb disability and function in people with PD. Further research is needed to inform measurement tool selection and treatment evaluation in this clinical group.

Section snippets

Methods

The review was conducted in 2 parts: an initial search to identify upper limb measures described in the PD literature and a second search to retrieve studies investigating the measurement properties of these tools in this clinical group. Both searches were conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol.14

Results

The study selection process for both searches is shown in the Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart (fig 1).

Discussion

This is the first comprehensive review of upper limb measurement tools described in PD, and their measurement properties. The identified tools included those designed specifically for PD or movement disorder evaluation, generic upper limb measures, and tools developed for other disease populations. PD-specific measures were generally linked to ICF impairment categories, whereas generic measures and tools developed for other conditions evaluated a range of impairments and activity limitations.

Conclusions

This review provides new information to guide clinicians and researchers in the selection of measurement tools for upper limb evaluation in people with PD. It also confirms existing gaps in our knowledge of upper limb measurement in this clinical population, in particular the lack of evidence for the validity and responsiveness of measures in current use. Without this information, it is difficult to correctly interpret the meaning of change in measurement after treatment and the effectiveness

Suppliers

  • a.

    Lafayette Instrument Co, 3700 Sagamore Pkwy, N Lafayette, IN 47904.

  • b.

    Wacom, 1311 SE Cardinal Crt, Vancouver, WA 98683.

  • c.

    Neuroscript LLC, 435 E Carson Dr, Tempe, AZ 85282.

  • d.

    Schuhfried GmbH, Hyrtlstrasse 45, 2340 Modling, Austria.

Acknowledgment

We thank Clarissa L. Martin, PhD, for her contribution to the initial development of the systematic review protocol/procedures.

References (64)

  • L. Manson et al.

    Survey of the hobbies and transport of patients with Parkinson’s disease

    Br J Occup Ther

    (1985)
  • I. Sturkenboom et al.

    Guidelines for occupational therapy in Parkinson’s disease rehabilitation

    (2011)
  • A.L. Fawcett

    Principles of assessment and outcome measurement for occupational therapists and physiotherapists: theory, skills and application

    (2007)
  • A. Aragon et al.

    The professional’s guide to Parkinson’s disease

    (2007)
  • S.H. Keus et al.

    KGNF Guidelines for physical therapy in patients with Parkinson’s disease

    (2004)
  • E.L. Proud et al.

    Upper-limb assessment in people with Parkinson disease: is it a priority for therapists, and which assessment tools are used?

    Physiother Can

    (2013)
  • H.C. de Vet et al.

    Measurement in medicine

    (2011)
  • World Health Organization

    International Classification of Functioning, Disability and Health

    (2001)
  • A. Cieza et al.

    Linking health-status measurements to the International Classification of Functioning, Disability and Health

    J Rehabil Med

    (2002)
  • D. Moher et al.

    The Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    PLoS Med

    (2009)
  • A. Cieza et al.

    ICF linking rules: an update based on lessons learned

    J Rehabil Med

    (2005)
  • M. Law

    Measurement in occupational therapy: scientific criteria for evaluation

    Can J Occup Ther

    (1987)
  • J.L. McGinley et al.

    Selection of clinical outcome measures in rehabilitation of people with movement disorders: theory and practice

  • C.B. Terwee et al.

    Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments

    Qual Life Res

    (2009)
  • F. Dobson et al.

    Clinimetric properties of observer-assessed impairment tests used to evaluate hip and groin impairments: a systematic review

    Arthritis Care Res

    (2012)
  • L. Mokkink et al.

    The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study

    Qual Life Res

    (2010)
  • C. Terwee et al.

    Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist

    Qual Life Res

    (2011)
  • S. Fahn et al.

    Clinical Rating Scale for Tremor

  • J.W. Langston et al.

    Core Assessment Program for Intracerebral Transplantations (CAPIT)

    Mov Disord

    (1992)
  • G.-L. Defer et al.

    Core Assessment Program for Surgical Interventional Therapies in Parkinson’s disease (CAPSIT-PD)

    Mov Disord

    (1999)
  • D.A. Heldman et al.

    The Modified Bradykinesia Rating Scale for Parkinson’s disease: reliability and comparison with kinematic measures

    Mov Disord

    (2011)
  • C.G. Goetz et al.

    Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results

    Mov Disord

    (2008)
  • Cited by (23)

    • Construct validity of the 9-Hole Peg Test and Purdue Pegboard Test in people with mild to moderately severe Parkinson's disease

      2020, Physiotherapy (United Kingdom)
      Citation Excerpt :

      There is also a need for health professionals to consider handedness and the asymmetrical presentation of PD symptoms in both assessment and treatment. A recent review of UL measurement tools in people with PD identified relatively few studies and an absence of high quality validity studies [6]. A previous survey of UL assessment in PD found that physiotherapists and occupational therapists often used standardised measures that were designed for stroke and other conditions and had not been clinimetrically evaluated for PD [7].

    • Reliability, validity and responsiveness of the squares test for manual dexterity in people with Parkinson's disease

      2019, Clinical Neurology and Neurosurgery
      Citation Excerpt :

      However, they are time-consuming and have special test materials. In addition, clinicians and researchers do not have suitable assessment tools which support the measurement properties, especially the validity and responsiveness [23–25]. The squares test (ST) is originally developed to determine handedness.

    • Quantitative assessment of upper limb functional impairments in people with Parkinson's disease

      2018, Clinical Biomechanics
      Citation Excerpt :

      In particular, the UPDRS-III allows characterization of motor signs such as bradykinesia and tremor (Hoffman and McNames, 2011; Proud et al., 2015; Stebbins and Goetz, 1998; Stewart et al., 2009). However, clinical scales are inherently subjective owing to their reliance on the physician's visual assessment of the movement and, generally speaking, it is difficult to summarize the movement with a concise score, especially when several aspects, such as speed and amplitude of movements, have to be taken into account for the evaluation of functional tasks (Proud et al., 2015). Moreover, such tools are unable to detect small, yet clinically relevant, changes since all items are scored on a limited point scale (Van der Noort et al., 2017).

    View all citing articles on Scopus

    Disclosures: none.

    View full text