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Rehabilitation Measures

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Purpose

The Profile PD is a scale consisting of 24 items that measures the impact of Parkinson Disease (PD) on body systems and activities. It quantifies the changes in the body system and activities in early and middle stages of the disease according to the Hoehn and Yahr classification. The Profile PD is designed to assess PD-specific impairments and activities through a combination of subjective report and observation in order to assist in examination and the assessment of outcomes through intervention.

The gold standard for quantifying the same variables is the UPDRS. However, the UPDRS is long and tends to emphasize responses weighted toward more advanced PD progression. Thus, it has limited clinical utility for physical therapists. In addition, the UPDRS contains details that are not needed for physical therapy assessment relative to assessment of effects of interventions. These are some of the factors that limit the use of this scale for physical therapists. The Profile PD addresses these factors.

Link to Instrument

Instrument Details

Acronym Profile PD

Area of Assessment

Activities of Daily Living
Balance – Non-vestibular
Cognition
Depression
Dexterity
Functional Mobility
Gait
Life Participation
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Parkinson's Disease & Movement Disorders

Key Descriptions

  • Profile PD consists of 24 total items organized into three subscales:
    1) Body Systems: Items #1-11 measure deficits in the body system including bradykinesia, tremor, and postural instability.
    2) Activities: Items #12-21 measure difficulties in functional activities that are experienced by the patient with PD.
    3) Cognition/Affect: Items #22-24 quantify impairments with memory, depression and degree of involvement in home and community.
  • Each item is rated on a scale from 0 (no problems) to 4 (significant problems).
  • Each item has its own scale descriptors.
  • The total score range is from 0 (best) to 96 (worse).

Number of Items

24

Equipment Required

  • Standard chair without armrests
  • Bottle of water and empty cup

Time to Administer

Approximately 10-20 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Hetal Bhimjiani, PT in 10/2012. Reviewed by Cathy Harro MS, PT, NCS & Member of PD EDGE task force of Neurology Section, APTA.

Body Part

Upper Extremity
Back
Lower Extremity

ICF Domain

Body Function
Activity

Measurement Domain

Activities of Daily Living
Cognition
Emotion
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

NR

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

No

Not reported

Vestibular EDGE

No

Yes

No

 

Considerations

The consideration are as follows:

  • The scale is a new scale developed to use with patients with early stages of Parkinson’s disease especially for the physical therapist since the scale requires less time for assessment and the scale is specific in terms of impairments and physical performance.
  • There is limited evidence (2 studies) therefore future studies should should be completed and published before the scale is adopted for clinical use by the physical therapist.
  • The scale needs further research to examine content, discriminative, and construct validity, test-retest reliabiilty, and responsiveness to disease progression and to therapeutic interventions.
  • There is a modified UPDRS that  is now available for the early stages of the disease but its correlation with Profile PD should be done.

 

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Parkinson's Disease

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Standard Error of Measurement (SEM)

Parkinson’s Disease:

(Schenkman and McFann, 2010; n = 86; mean age = 66 (10.0) years; mean time post diagnosis = 4.7 (4) years), mean H & Y = 2.3(0.4), mean UPDRS = 37.7(13.9), H & Y stage {1 = 1, 1.5 = 2, 2 = 42, 2.5 = 32, 3 = 4})

  • SEM = 1.52, calculated from article

Minimal Detectable Change (MDC)

Parkison’s Disease:

(Schenkman and McFann, 2010)

  • MDC = 4.214, calculated from article

Normative Data

Parkinson’s Disease:

(Schenkman and McFann, 2010)

  • Mean PROFILE PD score = 18.5±8.8, range 4-42

Interrater/Intrarater Reliability

Parkinson’s Disease:

(Schenkman and McFann, 2010; subset of PD sample, n = 15, H&Y stage 1.5-3 )

  • Excellent interrater reliability in individual with PD (ICC = 0.97)

Internal Consistency

Parkinson’s Disease:

(Schenkman and McFann, 2010)

  • The individual subscales were first evaluated for internal consistency with the following findings:
    • Impairment subscale: Excellent internal consistency (Cronbach’s Alpha = 0.82)
    • Physical Performance Subscale: Excellent internal consistency (Cronbach’s Alpha = 0.89)
    • Emotional Subscale: Poor internal consistency (Cronbach’s Alpha = 0.56)
  • Excellent internal consistency of the entire scale (Cronbach's alpha > 0.853)

Thus factor analysis at the final stage suggested this to be a single scale.

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease:

(Cutson et al, 1999; n = 40; mean age = 69.2(7.6) years)

  • Excellent correlations with the Hoehn and Yahr classification (= 0.73)
  • Adequate correlation of impairment subscale with Hoehn and Yahr classification (r = 0.54)
  • Adequate correlation of physical performance subscale with Schwab and England scale (= -0.57)
  • Adequate correlation of emotional subscale with CES-D (= 0.56)

Construct Validity

Parkinson’s Disease:

(Schenkman and McFann, 2010)

  • Excellent positive correlations between Profile PD and UPDRS (= 0.86)
  • Excellent negative correlation between Profile PD and Schwab & England Activities of Daily Living Scale (= -0.83)
  • Excellent correlation between Profile PD and Continuous Scale Physical Functional Performance test (= 0.62)

Face Validity

Items on body function and activity are consistent with items on UPDRS, and reflect commonly used examination items specific for PD to examine disease severity and effects on daily function.

Bibliography

Cutson, T. M., Sloane, R., et al. (1999). "Development of a clinical rating scale for persons with Parkinson's disease." J Am Geriatr Soc 47(6): 763-764. Find it on PubMed

Schenkman, M., McFann, K., et al. (2010). "PROFILE PD: profile of function and impairment level experience with Parkinson disease--clinimetric properties of a rating scale for physical therapist practice." J Neurol Phys Ther 34(4): 182-192. Find it on PubMed