COSMIN database

Systematic evaluation of rating scales for impairment and disability in Parkinson's disease

Ramaker, C., Marinus, J., Stiggelbout, A. M., and Van Hilten, B. J.
We assessed the clinometric characteristics of rating scales used for the evaluation of motor impairment and disability of patients with Parkinson's disease (PD), conducting a systematic review of PD rating scales published from 1960 to the present. Thirty studies describing clinometrics of 11 rating scales used for PD were identified. Outcome measures included validity (including factor structure), reliability (internal consistency, inter-rater, and intrarater) and responsiveness. We traced three impairment scales (Webster, Columbia University Rating Scale [CURS] and Parkinson's Disease Impairment Scale), four disability scales (Schwab and England, Northwestern University Disability Scale [NUDS], Intermediate Scale for Assessment of PD, and Extensive Disability Scale), and four scales evaluating both impairment and disability (New York University, University of California Los Angeles, Unified Parkinson's Disease Rating Scale [UPDRS], and Short Parkinson Evaluation Scale). The scales showed large differences in the extent of representation of items related to signs considered responsive to dopaminergic treatment or to those signs that appear late in the disease course and lack responsiveness to treatment. Regardless of the scale, there was a conspicuous lack of consistency concerning inter-rater reliability of bradykinesia, tremor, and rigidity. Overall disability items displayed moderate to good inter-rater reliability. The available evidence shows that CURS, NUDS, and UPDRS have moderate to good reliability and validity. In contrast to their widespread clinical use for assessment of impairment and disability in PD, the majority of the rating scales have either not been subjected to an extensive clinometric evaluation or have demonstrated clinometric shortcomings. The CURS, NUDS, and UPDRS are the most evaluated, valid, and reliable scales currently available.
Mov Disord
0885-3185 (Print)
Publication year:
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
6 - Clinical rating scales
7 - Observations
CURS - Columbia University Rating Scale
DUPRS - Duke University Parkinson’s Rating Scale
EDS - Extensive Disability Scale
ISAPD - Intermediate Scale for Assessment of Parkinson’s Disease
NUDS - Northwestern University Disability Scale
NYU - New York University Parkinson’s Disease Evaluation
PDIS - Parkinson’s Disease Impairment Scale
Schwab and England Scale
SPES/SCOPA - Short Parkinson’s Evaluation Scale / SCales for Outcomes in PArkinson’s disease   
UCLA - University of California, Los Angeles. scale
UPDRS-ME - Unified Parkinson’s Disease Rating Scale-Motor Evaluation
UPDRS - Unified Parkinson’s Disease Rating Scale   
Webster - Parkinson’s Disease Rating Scale by Webster