Objective: Assess inter-rater reliability and agreement on symptom laterality when the UPDRS is performed by two raters.

Background: The United Parkinson’s Disease Rating Scale (UPDRS) is the most widely known tool used to track disease progression. We compared UPDRS ratings performed by two movement disorders neurologists on the same 8 patients to analyze their inter-rater reliability for total scoring and agreement on which side has more severe tremor, bradykinesia, and rigidity.

Method: Two movement disorder neurologists performed a UPDRS on the same 8 patients at 2-3 time intervals. An intraclass correlation coefficient (ICC) was calculated to estimate inter-rater reliability across all visits. Cohen’s kappa was used to assess agreement between the raters for worse sides of tremor, bradykinesia, and rigidity. Intra-rater agreement on symptom laterality for individual raters was also calculated using Cohen’s kappa.

Results: Of the 40 scales, there was almost perfect agreement for total UPDRS scores between the two raters across all visits (ICC=0.93; 95% CI=0.61-0.98), specifically when rating rigidity and akinesia (0.84 CI=0.64-0.93; 0.82 CI=0.19-0.94). There was a weak level of agreement between the raters on laterality of tremor and bradykinesia across all visits (Kappa 0.58 CI=0.17-0.99; 0.41 CI=0.08-0.75) and minimal agreement on rigidity (-0.05 CI=-0.13-0.02). Both raters had a moderate level of agreement in determining the more affected side between the first and second time they performed the UPDRS on the same patient (0.79 CI=0.41-1.00; 0.6 CI=0.11- 1.00).

Conclusion: For these 8 patients who had 2-3 UPDRS scores performed by two movement disorders neurologists, there was moderate agreement between the raters on total scoring but weak to minimal agreement on symptom laterality for tremor, bradykinesia, and rigidity. Though our analysis is limited by small sample size, further data is needed to establish whether the UPDRS is a reliable tool for detecting clinically significant symptom laterality.

References: [1] Munhoz, R. P., Espay, A. J., Morgante, F., Li, J.-Y., Teive, H. A., Dunn, E., … Litvan, I. (2013). Long-duration Parkinsons disease: Role of lateralization of motor features. Parkinsonism & Related Disorders, 19(1), 77–80. doi: 10.1016/j.parkreldis.2012.07.008 [2] Post, B., Merkus, M. P., Bie, R. M. D., Haan, R. J. D., & Speelman, J. D. (2005). Unified Parkinsons disease rating scale motor examination: Are ratings of nurses, residents in neurology, and movement disorders specialists interchangeable? Movement Disorders, 20(12), 1577–1584. doi: 10.1002/mds.20640 [3] Siderowf, A., Mcdermott, M., Kieburtz, K., Blindauer, K., Plumb, S., & Shoulson, I. (2002). Test-Retest reliability of the Unified Parkinsons Disease Rating Scale in patients with early Parkinsons disease: Results from a multicenter clinical trial. Movement Disorders, 17(4), 758–763. doi: 10.1002/mds.10011

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MDS Abstracts - https://www.mdsabstracts.org/abstract/agreement-between-neurologists-on-updrs-scoring-and-symptom-laterality/