Background In PD, tremor severity behaves differently from other core motor features. However, the most commonly used assessment of overall motor severity, total MDS‐UPDRS Motor Examination (Part 3) score, does not account for this distinction. Objectives To investigate the Motor Examination (Part 3) using Item Response Theory approaches focusing on sample‐independent strategies that assess how well items measure latent models of PD motor severity. Methods Data from 6,298 PD patients were analyzed with graded response model Item Response Theory approaches involving two analyses all 33 Part 3 items versus the 10 tremor items and 23 bradykinesia, rigidity, gait, and posture items considered separately. The strength of relationship between items and the latent measure of parkinsonian motor severity (discrimination parameter) and calculated thresholds (location parameters) were assessed using the mirt program implemented in R (R Foundation for Statistical Computing, Vienna, Austria). Results Analyzing all Part 3 items together, nontremor items demonstrated good discrimination parameters (mean = 1.83 ± 0.37) and range of thresholds (–1.73 to +4.42), but tremor items had poor discrimination (mean = 0.52 ± 0.76) and thresholds (–0.69 to 14.29). Segregating nontremor from tremor items in two independent analyses provided markedly improved discrimination and location parameters for both. Conclusions MDS‐UPDRS Part 3 tremor and nontremor items have very different relations to the construct of PD severity. Strongly improved clinimetric properties for Part 3 are obtained when tremor and nontremor items are considered separately. We suggest that evaluating PD motor severity, as an operationalized summary measure, is best attained through separate analyses with tremor and nontremor motor scores. © 2020 International Parkinson and Movement Disorder Society
Objective: to perform a cross-term mapping of nursing language in the patient record with the Nursing Interventions Classification system, in rehabilitation patients with Parkinson's disease. Method: a documentary research study to perform cross mapping. A probabilistic, simple random sample composed of 67 records of patients with Parkinson's disease who participated in a rehabilitation program, between March of 2009 and April of 2013. The research was conducted in three stages, in which the nursing terms were mapped to natural language and crossed with the Nursing Interventions Classification. Results: a total of 1,077 standard interventions that, after crossing with the taxonomy and refinement performed by the experts, resulted in 32 interventions equivalent to the Nursing Interventions Classification (NIC) system. The NICs, "Education: The process of the disease.", "Contract with the patient", and "Facilitation of Learning" were present in 100% of the records. For these interventions, 40 activities were described, representing 13 activities by intervention. Conclusion: the cross mapping allowed for the identification of corresponding terms with the nursing interventions used every day in rehabilitation nursing, and compared them to the Nursing Interventions Classification.
Background: Summary scores of current clinical rating scales do not appear sensitive enough to quantify changes in disease progression in early Parkinson’s disease (PD) clinical trials. An alternate approach might be to track the appearance of new or emergent symptoms (ES) over time as a measure of disease progression. Objective: Explore the potential utility of patient reported ES as an outcome measure during the early phase of PD. Methods: We analyzed data from the MDS-UPDRS Parts IB (non-motor) and II (motor) Experiences of Daily Living scales over two years in the STEADY-PD3 study. We assessed the number of ES reported in each part of the scale in both participants who started symptomatic treatment and those who did not (STx-yes/no) in two periods: between 0 and 12-months (Year 1), and 13 and 24-months (Year 2). Results: Of 331 participants, 87% developed ES, and 55% started STx in Year 1. The median number of Part IB ES did not significantly differ between STx groups, but ES in Part II were significantly more frequent in the STx-yes group. Of 148 participants who remained STx-no into Year 2, 77% developed ES, and 42% started STx. Again, Part II, but not Part IB ES were more frequent the STx-yes group. Using these results, a sample size of ∼90 per group would be required to detect a 30% reduction in combined Part IB and II ES over 12 months. Conclusion: Assessing ES of patient-reported experiences of daily living may provide a useful marker for tracking PD progression.
Background: The complexity of motor and nonmotor symptoms in patients with Parkinson's disease (PD) requires multidisciplinary health actions. Objective: To describe the role of nurses as members of multidisciplinary teams tasked with treatment of motor and nonmotor symptoms and provide nursing protocols for the care of patients with Parkinson's disease. Methods: Analysis of the main diagnoses, outcomes, and ICNP ® interventions identified by cross-mapping empirical evidence described in 2123 nursing documents and data from medical records of patients with Parkinson's disease in the specialized rehabilitation program at the Sarah Network of Rehabilitation Hospitals in Brazil. The protocols were based on scientific evidence and international recommendations. Results: Clinical nursing protocols were developed based on a standardized nursing language of diagnoses, outcomes, and interventions focused on motor and nonmotor symptoms and principles of rehabilitation. Conclusion: These protocols are expected to guide the clinical reasoning of nurses for comprehensive care of patients with Parkinson's disease and their families.
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