Kenny Lorna, Azizi Zahra, Moore Kevin, Alcock Megan, Heywood Sarah, Johnson Agnes, McGrath Keith, Foley Mary J, Sweeney Brian, O'Sullivan Sean, Barton John, Tedesco Salvatore, Sica Marco, Crowe Colum, Timmons Suzanne
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork T12 XH60, Ireland.
Mercy University Hospital, Cork T12 WE28, Ireland.
Clin Park Relat Disord. 2024 Oct 28;11:100278. doi: 10.1016/j.prdoa.2024.100278. eCollection 2024.
Medication adjustments in Parkinson's disease (PD) are driven by patient subjective report and clinicians' rating of motor feature severity (such as bradykinesia and tremor).
As patients may be seen by different clinicians at different visits, this study aims to determine the inter-rater reliability of upper limb motor function assessment among clinicians treating people with PD (PwPD).
PwPD performed six standardised hand movements from the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS), while two cameras simultaneously recorded. Eight clinicians independently rated tremor and bradykinesia severity using a visual analogue scale. We compared intraclass correlation coefficient (ICC) before and after a training/calibration session where high-variance participant videos were reviewed and MDS-UPDRS instructions discussed.
In the first round, poor agreement was observed for most hand movements, with best agreement for resting tremor (ICC 0.66 bilaterally; right hand 95 % CI 0.50-0.82; left hand: 0.50-0.81). Postural tremor (left hand) had poor agreement (ICC 0.14; 95 % CI 0.04-0.33), as did wrist pronation-supination (right hand ICC 0.34; 95 % CI 0.19-0.56). In post-training rating exercises, agreements improved, especially for the right hand. Best agreement was observed for hand open-close ratings in the left hand (ICC 0.82, 95 % CI 0.64-0.94) and resting tremor in the right hand (ICC 0.92, 95 % CI 0.83-0.98). Discrimination between right and left hand features by raters also improved, except in resting tremor (disimprovement) and wrist pronation-supination (no change).
Clinicians vary in rating video-recorded PD upper limb motor features, especially bradykinesia, but this can be improved somewhat with training.
帕金森病（PD）的药物调整由患者主观报告和临床医生对运动特征严重程度（如运动迟缓、震颤）的评分驱动。
由于患者在不同就诊时可能由不同的临床医生诊治，本研究旨在确定治疗帕金森病患者（PwPD）的临床医生之间上肢运动功能评估的评分者间信度。
PwPD按照运动障碍协会统一帕金森病评定量表（MDS-UPDRS）进行六项标准化手部动作，同时两台摄像机同步记录。八位临床医生使用视觉模拟量表独立对震颤和运动迟缓的严重程度进行评分。在一个培训/校准环节中，我们回顾了高方差参与者的视频并讨论了MDS-UPDRS的使用说明，之后比较了组内相关系数（ICC）在培训前后的变化。
在第一轮中，大多数手部动作的一致性较差，静息性震颤的一致性最好（双侧ICC为0.66；右手95%置信区间为0.50-0.82；左手：0.50-0.81）。姿势性震颤（左手）的一致性较差（ICC为0.14；95%置信区间为0.04-0.33），腕关节旋前-旋后动作（右手ICC为0.34；95%置信区间为0.19-0.56）也是如此。在培训后的评分练习中，一致性有所提高，尤其是右手。左手开合动作评分的一致性最佳（ICC为0.82，95%置信区间为0.64-0.94），右手静息性震颤评分的一致性最佳（ICC为0.92，95%置信区间为0.83-0.98）。评分者对左右手部特征的区分能力也有所提高，但静息性震颤（变差）和腕关节旋前-旋后动作（无变化）除外。
临床医生对视频记录的帕金森病上肢运动特征的评分存在差异，尤其是运动迟缓，但通过培训可在一定程度上得到改善。
