Metric properties of nurses' ratings of parkinsonian signs with a modified Unified Parkinson's Disease Rating Scale
Metric properties of nurses' ratings of parkinsonian signs with a modified Unified Parkinson's Disease Rating Scale
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DOI：
10.1212/wnl.49.6.1580
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发表时间：
1997-12-01
期刊：
影响因子：
9.9
通讯作者：
Wilson, RS
中科院分区：
文献类型：
--
作者：
Bennett, DA;Shannon, KM;Wilson, RS
我们使用统一帕金森病评定量表(UPDRS)的运动部分的修订版来评估护士临床医生评估老年人帕金森症状的能力。在完成结构化培训方案后，三名护士临床医生和一名具有运动障碍专业知识的神经科医生对75名老年人进行了改良的UPDRS。大约3周后，护士们重复了这一评估。评估每个项目的评价者之间的一致性和短期的时间稳定性，修改后的UPDRS总分，以及运动迟缓、姿势反射障碍、僵硬和震颤的综合测量，以及帕金森征的总体评分。我们在芝加哥地区的天主教宗教社区进行了评估，使用了参与宗教秩序研究的四个社区的连续受试者，这是一项关于老年人的纵向临床病理学研究。我们的结果表明，护士不是一个显著的变异性来源，所有条目的组内相关都超过0.97，在大多数修改后的UPDRS条目上，护士与神经科医生表现出良好到极好的一致性。护士和神经科医生之间的相关性超过0.90的总修改的UPDRS，范围为0.76至0.95的帕金森四个领域的分数，并超过0.90的全球帕金森征分数。对于大多数修改后的UPDRS项目，护士们在3周的时间间隔内表现出相当到很好的一致性。在3周的间隔内，修改的UPDRS总分超过0.90，四个领域的得分从0.70到0.95不等，全球帕金森征得分超过0.90。护士临床医生对帕金森症状的评分与具有运动障碍专业知识的神经科医生的评分非常一致，并显示出良好的评分者间一致性和时间稳定性。经过适当的培训，护士临床医生可以可靠地实施改良的UPDRS。
We evaluated the ability of nurse clinicians to assess parkinsonian signs in older persons with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). After completing a structured training protocol, three nurse clinicians and a neurologist with expertise in movement disorders administered a modified UPDRS to 75 older persons. The nurses repeated the assessment about 3 weeks later. Inter-rater agreement and short-term temporal stability were estimated for each item, the total modified UPDRS score, and for summary measures of bradykinesia, postural reflex impairment, rigidity, and tremor, and a global parkinsonian sign score. We performed our assessment in Catholic religious communities in the Chicago area, using consecutive subjects at four communities participating in the Religious Orders Study, a longitudinal, clinical-pathologic study of older persons. Our results showed that nurses were not a significant source of variability, with intraclass correlations exceeding 0.97 for all items, and they showed good to excellent agreement with the neurologist for most modified UPDRS items. Correlations between nurses and neurologist exceeded 0.90 for the total modified UPDRS, ranged from 0.76 to 0.95 for the four parkinsonian domain scores, and exceeded 0.90 for the global parkinsonian sign score. Nurses showed fair to good agreement with themselves over the 3-week interval for most modified UPDRS items. Correlations over the 3-week interval exceeded 0.90 for the total modified UPDRS score, ranged from 0.70 to 0.95 for the four domain scores, and exceeded 0.90 for the global parkinsonian sign score. Ratings of parkinsonian signs by nurse clinicians corresponded closely to those of a neurologist with expertise in movement disorders and showed good inter-rater agreement and temporal stability. With appropriate training, nurse clinicians can reliably administer the modified UPDRS.