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  2. Schwab and England Activities of Daily Living Scale

Schwab and England Activities of Daily Living Scale

Last Updated

Purpose

An assessment of an individual's ability to function in activities of daily living.

Link to Instrument

Acronym SE-ADL or S&E

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Copies of the SE-ADL can be found in:

McRae, C., Diem, G., Vo, A., O'Brien, C., & Seeberger, L. (2002). Reliability of measurements of patient health status: a comparison of physician, patient, and caregiver ratings. Parkinsonism Relat Disord, 8(3), 187-192.

Diagnosis/Conditions

  • Parkinson's Disease & Movement Disorders

Populations

Parkinson's Disease
Mixed Populations

Key Descriptions

  • A short assessment typically involved within a greater assessment (Unified Parkinson’s Disease Rating Scale).
  • The examiner prompts the individual to select the rating that most accurately describes their level of functional independence and, frequently, incorporates the caregiver’s rating of the patient’s level of independence as well.
  • Rated in 10% increments:
    1) 100% = completely independent
    2) 0% = vegetative

Number of Items

1

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Originially reviewed by Jason Raad, M.S. Updated 4/19/2016 by Katie Merigold, Amy Morton, and Jordan Newmark.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Considerations

  • The Hoehn and Yahr and Unified Parkinson’s Disease Rating Scale are similar instruments used to categorize stages of Parkinson's disease.

  • No significant difference in ratings were observed between the Hoehn and Yahr and SE-ADL (McRae et al, 2002).

  • Patients with caregivers present may not be as likely to overestimate functional ability (McRae et al, 2002).

  • Significant agreement among raters was observed for both the Hoehn and Yahr and SE-ADL instruments.

  • The SE-ADL is part of the Unified Parkinson’s Disease Rating Scale.

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Parkinson's Disease

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Standard Error of Measurement (SEM)

Parkinson's Disease: (Dal Bello-Haas et al, 2011; n = 24; mean age = 64.9 (8.0) years; mean Mini–Mental State Exam scores 27.4 (2.5) points; mean Beck Depression Inventory II = 9.0 (5.6) points; Hoehn and Yahr scores, Stage 1 (n=13), Stage 2 (n=6), Stage 3 (n=5)

SE-ADL Standard Error of Measurement (SEM)

 

 

Measure

SEM

SEM 95% CI

SE-ADL

4.45

8.72

PDQ-8

1.96

3.84

SSE

0.81

1.59

NUDS

1.94

3.80

TUG

1.75

3.43

ABC

4.01

7.86

SE-ADL = Schwab & England Activities of Daily Living Scale

PDQ-8 = Parkinson’s Disease Questionnaire—Short Form

SSE = Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale

NUDS =  Northwestern University Disability Scale

TUG = Timed up-and-go test

ABC = Activities-specific Balance Confidence Scale

 

 

Minimal Detectable Change (MDC)

Parkinson's Disease: (Dal Bello-Haas et al, 2011)

MDC's for SE-ADL & related measures:

 

Measure

MDC95

SE-ADL

12.33

PDQ-8

5.43

SSE

2.25

NUDS

5.38

TUG

4.85

ABC

11.12

SE-ADL = Schwab & England Activities of Daily Living Scale

PDQ-8 = Parkinson’s Disease Questionnaire—Short Form

SSE = Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale

NUDS =  Northwestern University Disability Scale

TUG = Timed up-and-go test

ABC = Activities-specific Balance Confidence Scale

 

Minimally Clinically Important Difference (MCID)

Parkinson's Disease: (Shulman et al, 2010; n = 653; mean age = 65.9 (11.0) years; mean duration since onset = 6.3 (5.8) years mean Hoehn and Yahr stages 2.3 (0.9); mean Unified Parkinson’s Disease Rating Scale total score = 41.0 (20.5 points)

  • A 10 point (10%) change is SE-ADL ratings was found to be clinically significant (this assessment, however, was based partially on clinical experience)

Cut-Off Scores

SE-ADL Functional Rating Criteria: (McRae et al., 2002)

 

Rating

Description of ADL capability:

100%

Completely independent

90%

Completely independent. Beginning to be aware of difficulty.

80%

Completely independent. Conscious of difficulty and slowness.

70%

Not completely independent.

60%

Some dependency.

50%

More dependent.

40%

Very dependent.

30%

Much help needed.

20%

Severe invalid.

10%

Complete invalid.

0%

Bedridden and vegetative functions

Normative Data

Early-onset Parkinson’s Disease: (Filho et al, 2007; n = 45, Protégées sample)

SE-ADL means for patients diagnosed with and without depression:

 

 

 

 

Patients (n=45)

With depression (n=16)

Without depression (n=29)

Age at onset (years)

36.67±5.82 (19-45)

35.94±6.69 (19-44)

37.07±5.37 (28-45)

MMSE

28.6±2.7

28.6±2.3

28.5±2.9

Duration (years)

8.9±6.2

10.2±7.6

8.1±5.3

SE-ADL

78%±18.11

71%±24.28

83%±25

UPDRS/ motor scale

21.4±9.06

24.1±11.2

19.6±7.46

Hoehn-Yahr Staging Scale

2.4±0.9

2.65±0.94

2.25±0.80

MMSE = Mini-Mental State Examination

SE-ADL = Schwab-England ADL Scale

UPDRS = Unified Parkinson’s Disease Rating Scale

 

 

 

 

Patient SE-ADL scores as rated by the patient, caregiver and physician (McRae et al., 2002; n = 61 patients and 37 caregivers; mean Hoehn and Yahr (Doctor ratings), patients with caregivers = 3.11, without caregivers = 1.96):

SE-ADL Mean Rating for patients with and without caregivers:

 

 

 

 

 

 

With Caregivers

 

 

Without Caregivers

 

 

Doctor

Patient

Caregiver

Doctor

Patient

Mean Scores

60.86

57.43

57.97

90.43

80.83

 

Parkinson's Disease: (Shulman et al, 2010)

Cross-Sectional Analysis of Ratings on SE-ADL and the UPDRS:

 

 

 

 

SE-ADL

UPDRS Motor Score*

Diff**

UPDRS Total Score*

Diff**

100

15.3 (8.2)

 

19.9 (9.5)

 

90

19.7 (8.1)

4.5

28.1 (9.3)

8.3

80

26.4 (9.1)

6.7

39.8 (10.9)

11.7

70

32.4 (12.1)

6.0

50.3 (14.6)

10.8

60

37.1 (10.4)

4.7

57.6 (13.6)

7.4

50

34.2 (14.4)

?2.9

59.4 (18.3)

1.8

40

41.7 (12.6)

7.5

70.1 (13.8)

10.8

30

43.6 (18.1)

1.9

73.0 (23.0)

2.9

20

53.8 (10.3)

10.2

89.0 (16.2)

16.0

10

60.0 (7.1)

6.2

107.5 (7.2)

18.5

*Mean (SD)

**Difference for every 10% change in SE-ADL

 

 

 

 

Test/Retest Reliability

Parkinson's Disease: (Dal Bello-Haas et al, 2011) 

  • Adequate (ICC=.7) test-retest reliability

Interrater/Intrarater Reliability

Patient SE-ADL scores as rated by the patient, caregiver and physician (McRae et al., 2002)

  • Adequate inter-rater reliability (ICC = 0.60) between physicians, patients and caregivers
  • Adequate inter-rater  reliability between physicians and patients (ICC = .65)
    • Patients With Caregiver and physician ratings demonstrated significantly different SE-ADL ratings (physicians rated patients as being more functional)

Mixed Populations

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Normative Data

Dementia and Parkinson’s Disease: (Christ et al, 2013; n= 106; mean age = 79.4(19.9) years)

  • Parkinson’s disease non dementia n=85: Mean age =84.1(16.6)years
  • Parkinson’s disease with dementia n=21: Mean age =60.5(21.6) years
  • The S&E- ADL was not significant in discriminating between PDND and PDD in regards to level of assistance in activities of daily living P=0.08

 

Gait Speed in Parkinson’s Disease: (Hass et al., 2014; n= 324; mean age = 68(10); disease duration = 8(6); male= 216, female = 108) participants

Schawab and England

N

Mean (m/s)

SD

Difference

100

26

1.15

0.25

0.11

90

90

1.04

0.60

0.11

80

52

0.94

0.21

0.10

70

18

0.83

0.29

-0.07

60

3

0.90

0.24

0.23

50

4

0.67

0.24

 

Difference= change in gait velocity between consecutive Schwab and England levels

Construct Validity

Parkinson's Disease and Risk of Falling: (Dennison et al, 2007; n = 23 fallers and 25 fallers) 

  • Score on the SE-ADL did not discriminate between fallers and non-fallers

SE-ADL Scores among fallers and non-fallers:

 

 

 

Domain

Fallers

Non-fallers

p

Age (yrs)

73.96 (8.33)

75.16 (7.87)

0.69

Education (yrs)

14.39 (4.15)

12.28 (2.93)

0.10

Onset, Symptoms (mos)

135.68 (135.07)

87.28 (53.20)

0.25

Onset, Diagnosis (mos)

106.91 (87.73)

69.33 (43.76)

0.20

SE-ADL

73.06 (17.25)

80.65 (11.99)

0.17

Hoehn and Yahr (stage/5)

2.80 (0.70)

2.38 (0.56)

0.007

Mini-Mental Status Examination (Score/30)

25.83 (2.61)

27.05 (2.44)

0.18

 

Non-motor symptoms and Parkinson’s disease:(Kadastik-Eerme et al., 2015; n = 268; mean age = 74.2 (8.8) years; disease onset age = 66.8 (10.1) years; duration of disease = 7.6(5.9)) 

  • Moderate correlation was between SE-ADL and health related quality of life in PD patients
  • Health related quality of life was measured by the PDQ-39 (disease specific quality of life instrument)

Bibliography

Bertucci Filho, D., Teive, H. A., et al. (2007). "Early-onset Parkinson's disease and depression." Arq Neuropsiquiatr 65(1): 5-10. 

Christ, J.B., Berger, M.F., Riedl, E., Prakash, D., Csoti, I., Molt, W.,… Liepelt-Scarfone, I. (2013). How precise are activities of daily living scales for the diagnosis of Parkinson’s disease dementia? A pilot study. Parkinsonism & Related Disorders, 19(3), 371-374.

Dal Bello-Haas, V., Klassen, L., et al. (2011). "Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease." Physiother Can 63(1): 47-57. 

Dennison, A. C., Noorigian, J. V., et al. (2007). "Falling in Parkinson disease: identifying and prioritizing risk factors in recurrent fallers." American journal of physical medicine & rehabilitation 86(8): 621. 

Hass, C.J., Bishop, M., Moscovich, M., Stegem?ller, E.L., Skinner, J., Malaty, I.A.,… Okun, M.S. (2014). Defining the clinically meaningful difference in gait speed in persons with Parkinson disease. Journal of Neurologic Physical Therapy, 38(4). 233-238. 

Kadastik-Eerme, L., Rosenthal, M., Paju, T., Muldmaa, M., & Taba, P. (2015). Health-related quality of life in Parkinson’s disease: A cross-sectional study focusing on non-motor symptoms. Health and Quality of Life Outcomes Health Quality Life Outcomes, 13(1). 

McRae, C., Diem, G., et al. (2002). "Reliability of measurements of patient health status: a comparison of physician, patient, and caregiver ratings." Parkinsonism Relat Disord 8(3): 187-192. 

Shulman, L. M., Gruber-Baldini, A. L., et al. (2010). "The clinically important difference on the unified Parkinson's disease ra

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