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  2. Unified Dyskinesia Rating Scale

Unified Dyskinesia Rating Scale

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Purpose

Purpose of the scale: (Goetz C et al, 2008, n = 70; mean age = 65.2 (8.9) years; mean duration of PD = 13.3 (8.5) years; HY stage (2-4) years): Assess “On-Dyskinesia” (“choreic and dystonic movements explained to the patient as jerking or twisting movement that occurs when your medicine is working”) and off- Dystonia ( explained to patient as “spasms or cramps that can be painful and occur when your Parkinson’s disease medications are not taken or are not working”) in individuals with treated Parkinson’s disease (PD).

Link to Instrument

Instrument Details

Acronym UDysRS

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

  • Parkinson's Disease & Movement Disorders

Populations

Parkinson's Disease

Key Descriptions

  • Description of the scale (Goetz et al., 2008):
    1) There are 2 sections called the Historical and Objective.
    2) Historical section has Parts 1 and 2, which are further subdivided into 1A, 1B, 2A, and 2B.
    3) Objective section has Parts 3 and 4.
  • Part 1A: Is administered by the examiner. Examiner determines the total amount of time patient experiences “on dyskinesia” within past week and including the day of examination. The amount of time spent is then rated on a scale from 0-4:
    0) Normal - No dyskinesia
    1) Slight - < 25% of on-time
    2) Mild - 26-50% of on-time
    3) Moderate - 51-75% of on-time
    4) Severe - > 75% of on-time
  • Part 1B: Is a patient or caregiver questionnaire with questions analyzing the impact of dyskinesia specifically over the past week on patients' activities of daily living such as speech, chewing and swallowing, eating tasks, dressing, hygiene, handwriting, doing hobbies and other activities, walking and balance, public and social settings, exciting or emotional settings. Impact of dyskinesia in each of this situation is assessed using a 0-4 scale:
    0) Normal
    1) Slight
    2) Mild
    3) Moderate
    4) Severe
  • Part 2A: Examiner asks question concerning the duration of time in a day patient experienced off dystonia within past week and including the day of examination. The duration is then rated on a scale from 0-4:
    0) Never
    1) Less than 30 minutes a day
    2) Less than 60 minutes a day
    3) Less than 2 hours a day
    4) Greater than 2 hours a day
  • Part 2B: Is a patient or caregiver questionnaire and assesses the impact of off-period dystonia and pain associated with it on patient’s daily activities. The impact is then scored on a scale of 0-4:
    0) Normal
    1) Slight
    2) Mild
    3) Moderate
    4) Severe
  • Objective section or Parts 3 & 4:
    Examiner observes patient directly or using videotape and rates the Intensity of the Impairment and the Disability associated with the patient’s dyskinesia and dystonia during communication, drinking from a cup, dressing, and walking. The impairment ratings (intensity scale) are further assessed for each of the following seven body parts:
    1) Face
    2) Neck
    3&4) Arm/shoulder (right and left)
    5) Trunk
    6&7) Leg/hip (right and left)

Number of Items

Historical: 15
Objective: 11

Equipment Required

  • Picture (Cookie Thief Drawing recommended)
  • Cup filled with 4 oz water
  • Lab coat
  • Chair

Time to Administer

15 minutes

Required Training

Training Course

Instrument Reviewers

Initially reviewed by Poorva Kulkarni, PT in 12/2012; Updated with references from the PD population by Cathy C Harro PT, MS, NCS and the PD EDGE task force of the Neurology Section of the APTA in 4/25/13.

ICF Domain

Body Structure
Body Function
Activity
Participation

Considerations

The test is developed by the researchers of the Movement Disorder Society (Goetz et al., 2008).

According to the Movement Disorder Society task force (Colosimo et al., 2010):

  • Abnormal Involuntary Movement Scale and Rush Dyskinesia Rating scale are currently recommended scales to assess dyskinesia in Parkinson’s disease.
  • Although UDysRS has excellent reliability, it is a relatively new assessment tool and has not been used by other researchers outside the ones who developed the test, thus needing further research.
  • Responsiveness testing to an intervention; convergent, discrimination and content validity have not been determined.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Parkinson's Disease

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Normative Data

Parkinson’s Disease: 

(Suppa et al., 2011; {n = 20, 9 with dyskinesias (mean age 63 (6.8) years, mean UPDRS = 18 (7.3) on meds & UPDRS = 29 (8.8) off meds, mean disease duration = 9 (5.1), H&Y stage 1.5-3); and 11 without dyskinesias (mean age = 62 (8.1), mean UPDRS = 16 (4.6) on meds & UPDRS 26 (8.5) off meds, mean disease duration = 5 (3.7), H & Y 2-3)

  • Clinical evaluation of peak dose dyskinesias in PD patients with levodopa induced dyskinesia. UDysRS scores ranged from 17-56, with mean score = 30 (12.8)

Test/Retest Reliability

Parkinson’s Disease: 

(Goetz et al., 2011; n = 39; mean age = 63.7 (9.7) years; mean PD duration = 14.1(5.0) years) 

  • Excellent test-retest reliability (ICC = 0.822-0.513)

Interrater/Intrarater Reliability

Parkinson’s Disease: 

(Goetz et al., 2008; n = 70, H & Y stage 2-4, Range of dyskinesias (15 = no dyskinesia, 20 = mild, 20 = moderate, 15 = severe dyskinesias) )

  • Excellent interrater reliability (ICC = 0.87) for impairment section
  • Excellent interrater reliability (ICC = 0.91) for summary disability 
  • Excellent interrater reliability (ICC = 0.89) for total objective score 
  • Excellent intrarater reliability (ICC = 0.91) for impairment section 
  • Excellent intrarater reliability (ICC = 0.84) for summary disability 
  • Excellent intrarater reliability (ICC = 0.90) for total objective score 
  • Interrater reliability for impairment and disability items ranged from fair (kappa 0.4 to 0.59) to excellent (kappa > 0.8); with excellent total score reliability
  • Intrarater reliability for impairment and disability items ranges from fair (kappa 0.59) to excellent (kappa > 0.8), with excellent total score reliability

Internal Consistency

Parkinson’s Disease: 

(Goetz et al., 2008)

  • Excellent internal consistency (Cronbach’s alpha > 0.92) or subjective and objective rating section.

Content Validity

Parkinson’s Disease: 

(Goetz et al., 2011; n = 39; mean age 63.7 years, mean duration of PD = 14.1 years)

  • Temporal stability of UDysRS scores across an 8-hour observation period during clinical “on” and “off” states. Provides evidence that UDysRS is highly stable for individual patient’s ON and OFF periods, thus is a reliable estimate of score

Face Validity

Parkinson’s Disease:

(Goetz et al., 2008; n = 70, H & Y stage 2-4, Range of dyskinesias (15 = no dyskinesia, 20 = mild, 20 = moderate, 15 = severe dyskinesias)

  • Scale developed by a team of 20 international movement disorder experts (Goetz, 2008)
  • Excellent correlation between severity classification by the dyskinesia scale development team and patient self report (r = 0.81, p < 0.005)

Responsiveness

Parkinson’s Disease: 

(Goetz et al., 2013; n = 61 with PD and dyskinesias, H & & stages 1-4, mean duration of disease = 9.0 (3.5) years)

  • Able to detect significant treatment effects of Amantadine on dyskinesia, with Effect size = 0.138 (at 4 and 8 weeks compared to baseline scores); Better ability to measure change than a range of other dyskinesia rating scales and ADL rating scales

Bibliography

Colosimo, C., Martinez-Martin, P., et al. (2010). "Task force report on scales to assess dyskinesia in Parkinson's disease: critique and recommendations." Movement Disorders 25(9): 1131-1142.

Goetz, C. G., Nutt, J. G., et al. (2008). "The Unified Dyskinesia Rating Scale: presentation and clinimetric profile." Movement Disorders 23(16): 2398-2403.

Goetz, C. G., Nutt, J. G., et al. (2009). "Teaching program for the Unified Dyskinesia Rating Scale." Movement Disorders 24(9): 1296-1298.

Goetz, C. G., Stebbins, G. T., et al. (2013). "Which Dyskinesia Scale Best Detects Treatment Response?" Movement Disorders.

Goetz, C. G., Stebbins, G. T., et al. (2011). "Temporal stability of the Unified Dyskinesia Rating Scale." Movement Disorders 26(14): 2556-2559.

Suppa, A., Marsili, L., et al. (2011). "Lack of LTP-like plasticity in primary motor cortex in Parkinson's disease." Experimental neurology 227(2): 296-301.

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