Abbreviated MDS-UPDRS for Remote Monitoring in PD Identified Using Exhaustive Computational Search

Abstract

Background. The Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) comprises 50 items, consisting of historical questions and motor ratings, typically taking around 30 minutes to complete. We sought to identify an abbreviated version that could facilitate use in clinical practice or used remotely via telemedicine. Methods. To create an 8-item version we conducted an “exhaustive search” of all possible subsets. We measured explained variance in comparison to the 50-item version using linear regression, with the “optimal” subset maximising this while also meeting remote assessment practicality constraints. The subset was identified using a dataset collected by the Parkinson’s Progression Markers Initiative and validated using an MDS Non-Motor Symptoms Scale validation study dataset. Results. The optimal remote version comprised items from all parts of the MDS-UPDRS and was found to act as an unbiased estimator of the total 50-item score. This version had an explained variance score of 0.844 and was highly correlated with the total MDS-UPDRS score (Pearson’s r = 0.919, p -value <0.0001). Another subset that maximised explained variance score without adhering to remote assessment practicality constraints provided similar results. Conclusion. This result demonstrates that the total scores of an abbreviated form identified by computational statistics had high agreement with the MDS-UPDRS total score. Whilst it cannot capture the richness of information of the full MDS-UPDRS, it can be used to create a total score where practicality limits the application of the full MDS-UPDRS, such as remote monitoring. Further validation will be required, including in specific subgroups and advanced disease stages, and full validation of clinimetric properties.

Outcome Measures for Disease-Modifying Trials in Parkinson’s Disease: Consensus Paper by the EJS ACT-PD Multi-Arm Multi-Stage Trial Initiative

“…For assessment of motor features of PD, we included: the Hoehn and Yahr scale [9], the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) [10], the remote versions of both the Unified Parkinson's Disease Rating Scale (UPDRS) and the MDS-UPDRS [11][12][13], the UPDRS Gaitaxial score [14], and the Unified Dyskinesia Rating Scale (UDysRS) [15]. We also included scales on motor symptoms flagged as most bothersome by PPIE representatives, namely gait and balance problems (question about falls (e.g., Prevention of Falls Network Earth (ProFaNE) definition of a fall [16]), Mini-Balance Evaluation Systems Test (Mini-BESTest) [17], Berg Balance Scale [18], Falls Efficacy Scale International (FES-I) [19], and Activities-Specific Balance Confidence Scale (ABC Scale) [20]), and speech and swallowing issues (Generic Scale for Dysphagia-Related Outcomes (Quality of Life) (SWAL-QOL) [21][22][23][24], Swallowing Disturbance Questionnaire (SDQ) [25], and Radboud Oral Motor Inventory for Parkinson's Disease (ROMP) [26]).…”

Video-based activity recognition for automated motor assessment of Parkinson’s disease

“…In our dataset, every assessment has been recorded and saved in the form of multiple video clips, one video per item. We selected, for activity recognition model training, a subset of items that can be performed without assistance, taking into consideration overall informativeness about a patient's holistic disease state [24]. Some MDS-UPDRS items correspond to two distinct activities, such as left and right hand Finger Tapping.…”

Neurological Examination via Telemedicine: An Updated Review Focusing on Movement Disorders

“…The inability to examine rigidity remotely represents a major limitation for the assessment of patients with suspected parkinsonism. In these cases, the presence of a physician or another trained healthcare professional at the originating site is of paramount importance [ 47 ]. A study investigating the feasibility of the use of telemedicine for at-home titration in cases of LCIG infusion has demonstrated that most neurologists felt no significant limitations during the virtual evaluation of the patients, compared to hospital in-person assessment, as they could visually estimate postural instability and rigidity during the mobility of the patient [ 48 ].…”

“…A recent study using exhaustive computational searching methodology has identified a shortened 8-item version of the MDS-UPDRS with high agreement with the original MDS-UPDRS that can be administered remotely [ 47 ]. In particular, the researchers of this study initially excluded the items of rigidity and retropulsion testing, as well as those that require the inspection of lower limbs (toe tapping, leg agility, gait, freezing of gait, posture, and body bradykinesia), since during remote examination patients usually use a digital device (smartphone, tablet, or computer) placed in front of them on a table or desk [ 47 ]. This proposed abbreviated MDS-UPDRS version for the remote assessment included the following items: 1.13 fatigue, 2.5 dressing, 2.10 tremor, 2.12 walking and balance, 3.2 facial movements, 3.4 finger tapping, 3.9 rising from chair, and 4.3 time spent in the off state [ 47 ].…”