Functional assessment of the Parkinsonian upper limb: Validity and intra- and inter-reliability of the MSPIR test

Abstract

There is no valid functional scale to assess the Parkinsonian upper limb. The Mount Sinai Parkinsonism Impairment Rating (MSPIR) test times 12 everyday living functional tasks (6 uni- and 6 bimanual). The aim of the study was to explore the inter- and intra-rater reliability and the correlations with clinical parameters (MDS-UPDRS-III, GMT) of the MSPIR test. Twenty-five subjects with Parkinsonian syndromes were included (13 women; age 67.1 ± 7.9, mean MDS-UPDRS-III 24.9 ± 13.2, mean seat-to-stand 15-second frequency 0.39 ± 0.21 Hz, mean delay since symptom onset 11.1 ± 8.3 years) based on the following inclusion criteria: Parkinsonian syndrome for over a year, Hoehn & Yahr between I and III. Patients were filmed on the OFF state. Each task was timed on video-review by 9 raters, twice one week apart. Intra- and inter-rater reliability was analysed by intraclass correlation coefficients, standard deviations and coefficients of variation. For the MSPIR total time, the mean inter- and intra-rater ICC were respectively 0.99 (0.98–1) and 1 (0.97–1) (mean, 95% CI). Standard intra-rater and inter-rater were 1.3 (0.1) and 15.7 (0.7) s respectively. Inter-rater coefficient of variation was 6%. The time for each task was correlated with the total time. Total MSPIR time was positively correlated with UPDRS-III, the number of years since diagnosis, the levodopa daily equivalent dose, Hoehn & Yahr stage, GMT and negatively with seat-to-stand and large movement frequencies. Crohnbach's alpha coefficient was 0.99. To assess rehabilitation, the MSPIR quantifies functional bradykinesia in the upper limb for mild Parkinsonian patients. Its reliability and concurrent validity are excellent.