Clinicians’ Tendencies to Under-Rate Parkinsonian Tremors in the Less Affected Hand

Abstract

The standard assessment method for tremor severity in Parkinson’s disease is visual observation by neurologists using clinical rating scales. This is, therefore, a subjective rating that is dependent on clinical expertise. The objective of this study was to report clinicians’ tendencies to under-rate Parkinsonian tremors in the less affected hand. This was observed through objective tremor measurement with accelerometers. Tremor amplitudes were measured objectively using tri-axis-accelerometers for both hands simultaneously in 53 patients with Parkinson’s disease during resting and postural tremors. The videotaped tremor was rated by neurologists using clinical rating scales. The tremor measured by accelerometer was compared with clinical ratings. Neurologists tended to under-rate the less affected hand in resting tremor when the contralateral hand had severe tremor in Session I. The participating neurologists corrected this tendency in Session II after being informed of it. The under-rating tendency was then repeated by other uninformed neurologists in Session III. Kappa statistics showed high inter-rater agreements and high agreements between estimated scores derived from the accelerometer signals and the mean Clinical Tremor Rating Scale evaluated in every session. Therefore, clinicians need to be aware of this under-rating tendency in visual inspection of the less affected hand in order to make accurate tremor severity assessments.

An Ambulatory Tremor Score for Parkinson’s Disease

“…All assessments, including the use of the Parkinson's KinetiGraph (PKG) and clinical rating scales were performed as part of routine care or as part of disparate research studies which received approval from the St Vincent's Hospital Human Research & Ethics Committee (Approval Number: QA 072- 14) to review the medical records of patients whose data was used in this paper. The committee gave approval as a quality assurance study and waived the need for written informed consent from the participants.…”

“…There are numerous examples of the use of accelerometry to analyse the tremor of PD, especially with the advent of easily accessible, high quality accelerometers in smart phones [10][11][12][13][14] and well established tremor detection algorithms [15,16]. We have described an accelerometer-based system for automated assessment of dyskinesia and bradykinesia [9].…”

Discrimination between healthy and patients with Parkinson’s disease from hand resting activity using inertial measurement unit

“…Although being the most widely used, the UPDRS does have its limitations, due to the time consumed in its application and its high degree of subjectivity [ 12 ]. An example of the said subjectivity is presented in studies that show a tendency of evaluators to underestimate the severity of the tremor on the least affected side, when the other side presents a severe tremor; this tendency is attributed to less attention being given to the least affected side [ 16 ]. The use of an objective method minimizes the need for an experienced professional being involved in the diagnosis process, as it is not always that the patients have such a professional at hand.…”

Discriminação do tremor em repouso do punho entre indivíduos com e sem a doença de parkinson por meio de sensores inerciais e classificadores

“…Apesar de ser a mais utilizada, a UPDRS possui algumas limitações, pois consome muito tempo para ser aplicada e possui um alto grau de subjetividade Kuhner ( 2017). Um exemplo desta subjetividade é apresentado em estudos que mostram uma tendência dos avaliadores em subavaliar a gravidade do tremor do lado menos afetado quando o outro lado apresenta um tremor severo Lee (2015). Desta forma, com o uso da UPDRS, o diagnóstico acaba sendo mais dependente do profissional que o realiza em detrimento do paciente, pois a experiência do profissional acaba sendo um fator tão decisivo quanto a apresentação dos sintomas no momento do diagnóstico.…”

“…Um exemplo desta subjetividade é apresentado em estudos que mostram uma tendência dos avaliadores em subavaliar a gravidade do tremor do lado menos afetado quando o outro lado apresenta um tremor severo. Nestes casos o avaliador tende a avaliar o lado menos acometido de forma menos grave do que deveria (LEE et al, 2015). Desta forma, o mesmo paciente pode receber diagnósticos diferentes de diferentes avaliadores.…”