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- Löhle, Matthias, et al.
(författare)
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Validation of the PD home diary for assessment of motor fluctuations in advanced Parkinson's disease
- 2022
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Ingår i: npj Parkinson's Disease. - : Springer Science and Business Media LLC. - 2373-8057. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- The Parkinson's disease (PD) home diary is frequently used in clinical trials to measure efficacy of medical treatments for motor fluctuations in advanced PD. This prospective study in fluctuating PD patients examines the validity of the diary for quantification of motor states in comparison to direct clinical observation. 51 patients (median age: 65 years, disease duration: 11 years) completed the diary half-hourly for two consecutive days and were simultaneously rated by an experienced observer, who independently evaluated motor states half-hourly throughout daytime. Overall agreement (Cohen's kappa) between patient and observer diary entries was 59.8% (0.387). Patients documented more On without dyskinesia (52.3% vs. 38.9%, P < 0.001) and less On with dyskinesia (21.5% vs. 34.2%, P < 0.001), whereas proportions for Off intervals were not different between patient and observer diaries (26.2% vs. 27.0%, P = 0.97). Temporal agreement between diary ratings was unsatisfactory, particularly for On with dyskinesia. Taken together, our study suggests that the PD home diary only inadequately reflects actual motor states compared to direct clinical observation.
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| 2. |
- Timpka, Jonathan, et al.
(författare)
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Objective Observer vs. Patient Motor State Assessments Using the PD Home Diary in Advanced Parkinsons Disease
- 2022
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Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Parkinson Disease (PD) Home Diary (HD) is a commonly used clinical outcome measure, but it has not been extensively compared to direct assessments by experienced observers. Objective: Validation of patient-reported HD by investigating the agreement between motor state assessments by patients and observers. Methods: This observational study included patients with PD and motor fluctuations. Observers were physicians or research nurses. Patients completed a screening visit, one day of diary ratings at home, and then two days of ratings on-site during which patients and observers simultaneously judged the participants motor state. Results: Observers and 40 patients completed 1,288 pairs of half-hourly blinded motor state assessments. There were significant differences between observer and patient ratings (P < 0.001) and the temporal agreement was poor (Cohens kappa = 0.358). The agreement between patient and observer ratings was 71.1% for observed "On without dyskinesia", 57.3% for observed "Off", and 49.4% for observed "On with dyskinesia". Daily times spent in the three motor states as aggregated diary data showed fair to excellent reliability with intraclass coefficient values ranging from 0.45 to 0.52 for "On" and 0.77 for "Off". Conclusion: There were significant differences between observer and patient ratings. Patients and observers generally agreed on when the patients was in the "On" state (with or without dyskinesia). Patient ratings on the hour level seem to be influenced by other aspects of the patients experience than the observed motor state, but assessment of daily time spent in the different motor state provides reasonable reliability.
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