The purpose of this investigation was to develop a rating scale that would be appropriate to use with people who are in early and middle stages of Parkinson's disease. Patients in these stages of the disease are still able to walk independently, to carry out most activities of daily living without assist, and generally to live independently. Most available rating scales are not specific for early and mid-stage disease, but rather are used across all stages of the disease, including patients who are totally dependent. Often they are not sensitive to particular changes in the earlier stages. The Duke University Parkinson's Disease Rating Scale (DUPRS) is a 22 item scale, with four gradations for each item (from not impaired to most impaired). The DUPRS is divided into three subscales (symptoms of the disease, physical performance, and psychological/cognitive symptoms). To determine whether the scale could be used by different professionals, a videotaped interview with 5 patients was scored by 16 raters from 4 different professions (geriatricians, neurologists, physical therapists, and nurses). Results demonstrated no difference in ability to rate the material by the different professionals. To determine whether different raters could elicit the same information, two raters (a geriatrician and a physical therapist) independently rated 38 subjects. Results indicated that different raters can elicit the same information. To determine whether the DUPRS subscales were valid measures of the intended information, the ratings of each subject on the three subscales were compared to ratings of subjects on established scales. Results indicated good agreement with information obtained from other established scales. In summary, a rating scale has been developed that is useful across professionals, that can be used reproducibly by different ratings, and that measures the intended information. Further testing of this scale will be performed. We will determine its sensitivity for identifying changes with progression of disease as well as improvements with specific interventions.
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