Article

Minimal clinically important change on the Unified Parkinson's Disease Rating Scale

Royal Free and University College Medical School, University College London, London, United Kingdom.
Movement Disorders (Impact Factor: 5.63). 08/2006; 21(8):1200-7. DOI: 10.1002/mds.20914
Source: PubMed

ABSTRACT The Unified Parkinson's Disease Rating Scale (UPDRS) is the main outcome measure in clinical trials of Parkinson's disease (PD). The minimal change that represents a clinically meaningful improvement is unknown. The objective of this study was to determine the minimal change on the UPDRS that represents a clinically meaningful improvement in early PD after 6 months of treatment. Data from two independent randomized treatment trials over 6 months involving 603 patients with de novo PD were analyzed to determine the minimal clinically important change (MCIC), referred to the status before treatment, for the UPDRS motor, activities of daily living (ADL), and total scores. An anchor-based method using ratings on a seven-point global clinical improvement was used. A change of five points on the UPDRS motor part was found to be the most appropriate cutoff score for all Hoehn and Yahr stages I to III, and a change of eight points for the UDPRS total score. For the UDPRS ADL score, an MCIC of two points for Hoehn and Yahr stages I/I.5 and II and of three points for Hoehn and Yahr stage II.5/III was the most appropriate cutoff score. These data give the first estimate for cutoffs defining clinically important changes in UPDRS ADL and motor scores. Further studies using larger databases from more diverse study populations are encouraged to better define and solidify the MCIC for the UPDRS.

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    • "There is a paucity of MCID data based on a patient-rated tool, such as the Patient-rated Global Impression of Improvement (PGI-I). Most of the published MCID data focus on patients with early PD and come from clinical trials of ropinirole or rasagiline [3] [6], but not pramipexole. Using both PGI-I and CGI-I as anchors, we describe MCID data from two placebo-controlled studies of pramipexole extended release (ER) in patients with early PD (EPD) and advanced PD (APD). "
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    ABSTRACT: Background. The minimal clinically important difference (MCID) is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson's Disease Rating Scale (UPDRS) scores in early Parkinson's disease (EPD) and for UPDRS scores and "OFF" time in advanced Parkinson's disease (APD). Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR) as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves "a little better" on patient global impression of improvement (PGI-I) minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR) for UPDRS II were -1.8 and -2.0, for UPDRS III -6.2 and -6.1, and for UPDRS II + III -8.0 and -8.1. MCIDs in APD for UPDRS II were -1.8 and -2.3, for UPDRS III -5.2 and -6.5, and for UPDRS II + III -7.1 and -8.8. MCID for "OFF" time (pramipexole ER, pramipexole IR) was -1.0 and -1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.
    Parkinson's Disease 04/2014; 2014:467131. DOI:10.1155/2014/467131 · 2.10 Impact Factor
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    • "Recent studies regarding minimal clinically important change (MCIC), which was to assess therapeutic interventions for Parkinson's disease, suggested that cutoffs for a MCIC are scores of 2.5–5 points on UPDRS part III and 5–8 points on combined UPDRS parts II þ III [2] [3] [4]. "
    Parkinsonism & Related Disorders 09/2013; 19(9). DOI:10.1016/j.parkreldis.2013.08.018 · 4.13 Impact Factor
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    • "Such a change is considered to be clinically significant due to its impact on functional disability in early PD [26] . "
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    ABSTRACT: Parkinson's disease (PD) is a chronic progressive neurodegenerative disease that is clinically manifested by a triad of cardinal motor symptoms - rigidity, bradykinesia and tremor - due to loss of dopaminergic neurons. The motor symptoms of PD become progressively worse as the disease advances. PD is also a heterogeneous disease since rigidity and bradykinesia are the major complaints in some patients whereas tremor is predominant in others. In recent years, many studies have investigated the progression of the hallmark symptoms over time, and the cardinal motor symptoms have different rates of progression, with the disease usually progressing faster in patients with rigidity and bradykinesia than in those with predominant tremor. The current treatment regime of dopamine-replacement therapy improves motor symptoms and alleviates disability. Increasing the dosage of dopaminergic medication is commonly used to combat the worsening symptoms. However, the drug-induced involuntary body movements and motor complications can significantly contribute to overall disability. Further, none of the currently-available therapies can slow or halt the disease progression. Significant research efforts have been directed towards developing neuroprotective or disease-modifying agents that are intended to slow the progression. In this article, the most recent clinical studies investigating disease progression and current progress on the development of disease-modifying drug trials are reviewed.
    Neuroscience Bulletin 02/2012; 28(1):39-48. DOI:10.1007/s12264-012-1050-z · 1.83 Impact Factor
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