Williams, S orcid.org/0000-0002-4786-1356, Wong, D orcid.org/0000-0001-8117-9193, Alty, JE et al. (1 more author) (2023) Parkinsonian Hand or Clinician’s Eye? Finger Tap Bradykinesia Interrater Reliability for 21 Movement Disorder Experts. Journal of Parkinson's Disease, 13 (4). pp. 525-536. ISSN 1877-7171
Abstract
Background:
Bradykinesia is considered the fundamental motor feature of Parkinson’s disease (PD). It is central to diagnosis, monitoring, and research outcomes. However, as a clinical sign determined purely by visual judgement, the reliability of humans to detect and measure bradykinesia remains unclear.
Objective:
To establish interrater reliability for expert neurologists assessing bradykinesia during the finger tapping test, without cues from additional examination or history.
Methods:
21 movement disorder neurologists rated finger tapping bradykinesia, by Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and Modified Bradykinesia Rating Scale (MBRS), in 133 videos of hands: 73 from 39 people with idiopathic PD, 60 from 30 healthy controls. Each neurologist rated 30 randomly-selected videos. 19 neurologists were also asked to judge whether the hand was PD or control. We calculated intraclass correlation coefficients (ICC) for absolute agreement and consistency of MDS-UPDRS ratings, using standard linear and cumulative linked mixed models.
Results:
There was only moderate agreement for finger tapping MDS-UPDRS between neurologists, ICC 0.53 (standard linear model) and 0.65 (cumulative linked mixed model). Among control videos, 53% were rated > 0 by MDS-UPDRS, and 24% were rated as bradykinesia by MBRS subscore combination. Neurologists correctly identified PD/control status in 70% of videos, without strictly following bradykinesia presence/absence.
Conclusion:
Even experts show considerable disagreement about the level of bradykinesia on finger tapping, and frequently see bradykinesia in the hands of those without neurological disease. Bradykinesia is to some extent a phenomenon in the eye of the clinician rather than simply the hand of the person with PD.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2023 The authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License. |
Keywords: | Parkinson’s disease, bradykinesia, finger tapping, interrater reliability, intraclass correlation coefficients, MBRS, MDS-UPDRS |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Centre for Health Services Research (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 30 Jun 2023 09:18 |
Last Modified: | 30 Jun 2023 09:18 |
Status: | Published |
Publisher: | IOS Press |
Identification Number: | 10.3233/jpd-223256 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:201051 |
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