METRIC PROPERTIES OF NURSES RATINGS OF PARKINSONIAN SIGNS WITH A MODIFIED UNIFIED PARKINSONS-DISEASE RATING-SCALE

We evaluated the ability of nurse clinicians to assess parkinsonian si gns in older persons with a modified version of the motor section of t he Unified Parkinson's Disease Rating Scale (UPDRS). After completing a structured training protocol, three nurse clinicians and a neurologi st 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 es timated for each item, the total modified UPDRS score, and for summary measures of bradykinesia, postural reflex impairment, rigidity, and t remor, and a global parkinsonian sign score. We performed our assessme nt in Catholic religious communities in the Chicago area, using consec utive subjects at four communities participating in the Religious Orde rs Study, a longitudinal, clinical-pathologic study of older persons. Our results showed that nurses were not a significant source of variab ility, 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 exce eded 0.90 for the total modified UPDRS, ranged from 0.76 to 0.95 for t he four parkinsonian domain scores, and exceeded 0.90 for the global p arkinsonian sign score. Nurses showed fair to good agreement with them selves over the 3-week interval for most modified UPDRS items. Correla tions over the 3-week interval exceeded 0.90 for the total modified UP DRS score, ranged from 0.70 to 0.95 for the four domain scores, and ex ceeded 0.90 for the global parkinsonian sign score. Ratings of parkins onian signs by nurse clinicians corresponded closely to those of a neu rologist with expertise in movement disorders and showed good inter-ra ter agreement and temporal stability. With appropriate training, nurse clinicians can reliably administer the modified UPDRS.