Schwab and England Activities of Daily Living Scale

Last Updated

April 19, 2016

Purpose

An assessment of an individual's ability to function in activities of daily living.

Link to Instrument

Instrument details

Acronym SE-ADL or S&E

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Copies of the SE-ADL can be found in:

McRae, C., Diem, G., Vo, A., O'Brien, C., & Seeberger, L. (2002). Reliability of measurements of patient health status: a comparison of physician, patient, and caregiver ratings. Parkinsonism Relat Disord, 8(3), 187-192.

Diagnosis/Conditions

Parkinson's Disease & Movement Disorders

Parkinson's Disease

Mixed Populations

A short assessment typically involved within a greater assessment (Unified Parkinson’s Disease Rating Scale).
The examiner prompts the individual to select the rating that most accurately describes their level of functional independence and, frequently, incorporates the caregiver’s rating of the patient’s level of independence as well.
Rated in 10% increments:
1) 100% = completely independent
2) 0% = vegetative

Number of Items

5-10 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Originially reviewed by Jason Raad, M.S. Updated 4/19/2016 by Katie Merigold, Amy Morton, and Jordan Newmark.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Considerations

The Hoehn and Yahr and Unified Parkinson’s Disease Rating Scale are similar instruments used to categorize stages of Parkinson's disease.
No significant difference in ratings were observed between the Hoehn and Yahr and SE-ADL (McRae et al, 2002).
Patients with caregivers present may not be as likely to overestimate functional ability (McRae et al, 2002).
Significant agreement among raters was observed for both the Hoehn and Yahr and SE-ADL instruments.
The SE-ADL is part of the Unified Parkinson’s Disease Rating Scale.

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Standard Error of Measurement (SEM)

Parkinson's Disease: (Dal Bello-Haas et al, 2011; n = 24; mean age = 64.9 (8.0) years; mean Mini–Mental State Exam scores 27.4 (2.5) points; mean Beck Depression Inventory II = 9.0 (5.6) points; Hoehn and Yahr scores, Stage 1 (n=13), Stage 2 (n=6), Stage 3 (n=5)

SE-ADL Standard Error of Measurement (SEM)
Measure	SEM	SEM 95% CI
SE-ADL	4.45	8.72
PDQ-8	1.96	3.84
SSE	0.81	1.59
NUDS	1.94	3.80
TUG	1.75	3.43
ABC	4.01	7.86
SE-ADL = Schwab & England Activities of Daily Living Scale PDQ-8 = Parkinson’s Disease Questionnaire—Short Form SSE = Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale NUDS = Northwestern University Disability Scale TUG = Timed up-and-go test ABC = Activities-specific Balance Confidence Scale

Minimal Detectable Change (MDC)

Parkinson's Disease: (Dal Bello-Haas et al, 2011)

MDC's for SE-ADL & related measures:
Measure	MDC95
SE-ADL	12.33
PDQ-8	5.43
SSE	2.25
NUDS	5.38
TUG	4.85
ABC	11.12
SE-ADL = Schwab & England Activities of Daily Living Scale PDQ-8 = Parkinson’s Disease Questionnaire—Short Form SSE = Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale NUDS = Northwestern University Disability Scale TUG = Timed up-and-go test ABC = Activities-specific Balance Confidence Scale

Minimally Clinically Important Difference (MCID)

Parkinson's Disease: (Shulman et al, 2010; n = 653; mean age = 65.9 (11.0) years; mean duration since onset = 6.3 (5.8) years mean Hoehn and Yahr stages 2.3 (0.9); mean Unified Parkinson’s Disease Rating Scale total score = 41.0 (20.5 points)

A 10 point (10%) change is SE-ADL ratings was found to be clinically significant (this assessment, however, was based partially on clinical experience)

Cut-Off Scores

SE-ADL Functional Rating Criteria: (McRae et al., 2002)
Rating	Description of ADL capability:
100%	Completely independent
90%	Completely independent. Beginning to be aware of difficulty.
80%	Completely independent. Conscious of difficulty and slowness.
70%	Not completely independent.
60%	Some dependency.
50%	More dependent.
40%	Very dependent.
30%	Much help needed.
20%	Severe invalid.
10%	Complete invalid.
0%	Bedridden and vegetative functions

Normative Data

Early-onset Parkinson’s Disease: (Filho et al, 2007; n = 45, Protégées sample)

SE-ADL means for patients diagnosed with and without depression:
	Patients (n=45)	With depression (n=16)	Without depression (n=29)
Age at onset (years)	36.67±5.82 (19-45)	35.94±6.69 (19-44)	37.07±5.37 (28-45)
MMSE	28.6±2.7	28.6±2.3	28.5±2.9
Duration (years)	8.9±6.2	10.2±7.6	8.1±5.3
SE-ADL	78%±18.11	71%±24.28	83%±25
UPDRS/ motor scale	21.4±9.06	24.1±11.2	19.6±7.46
Hoehn-Yahr Staging Scale	2.4±0.9	2.65±0.94	2.25±0.80
MMSE = Mini-Mental State Examination SE-ADL = Schwab-England ADL Scale UPDRS = Unified Parkinson’s Disease Rating Scale

Patient SE-ADL scores as rated by the patient, caregiver and physician (McRae et al., 2002; n = 61 patients and 37 caregivers; mean Hoehn and Yahr (Doctor ratings), patients with caregivers = 3.11, without caregivers = 1.96):

SE-ADL Mean Rating for patients with and without caregivers:
	With Caregivers			Without Caregivers
	Doctor	Patient	Caregiver	Doctor	Patient
Mean Scores	60.86	57.43	57.97	90.43	80.83

Parkinson's Disease: (Shulman et al, 2010)

Cross-Sectional Analysis of Ratings on SE-ADL and the UPDRS:
SE-ADL	UPDRS Motor Score*	Diff**	UPDRS Total Score*	Diff**
100	15.3 (8.2)		19.9 (9.5)
90	19.7 (8.1)	4.5	28.1 (9.3)	8.3
80	26.4 (9.1)	6.7	39.8 (10.9)	11.7
70	32.4 (12.1)	6.0	50.3 (14.6)	10.8
60	37.1 (10.4)	4.7	57.6 (13.6)	7.4
50	34.2 (14.4)	−2.9	59.4 (18.3)	1.8
40	41.7 (12.6)	7.5	70.1 (13.8)	10.8
30	43.6 (18.1)	1.9	73.0 (23.0)	2.9
20	53.8 (10.3)	10.2	89.0 (16.2)	16.0
10	60.0 (7.1)	6.2	107.5 (7.2)	18.5
Mean (SD) *Difference for every 10% change in SE-ADL

Test/Retest Reliability

Parkinson's Disease: (Dal Bello-Haas et al, 2011)

Adequate (ICC=.7) test-retest reliability

Interrater/Intrarater Reliability

Patient SE-ADL scores as rated by the patient, caregiver and physician (McRae et al., 2002)

Adequate inter-rater reliability (ICC = 0.60) between physicians, patients and caregivers
Adequate inter-rater reliability between physicians and patients (ICC = .65)
- Patients With Caregiver and physician ratings demonstrated significantly different SE-ADL ratings (physicians rated patients as being more functional)

Normative Data

Dementia and Parkinson’s Disease: (Christ et al, 2013; n= 106; mean age = 79.4(19.9) years)

Parkinson’s disease non dementia n=85: Mean age =84.1(16.6)years
Parkinson’s disease with dementia n=21: Mean age =60.5(21.6) years
The S&E- ADL was not significant in discriminating between PDND and PDD in regards to level of assistance in activities of daily living P=0.08

Gait Speed in Parkinson’s Disease: (Hass et al., 2014; n= 324; mean age = 68(10); disease duration = 8(6); male= 216, female = 108) participants

Schawab and England	N	Mean (m/s)	SD	Difference
100	26	1.15	0.25	0.11
90	90	1.04	0.60	0.11
80	52	0.94	0.21	0.10
70	18	0.83	0.29	-0.07
60	3	0.90	0.24	0.23
50	4	0.67	0.24

Difference= change in gait velocity between consecutive Schwab and England levels

Construct Validity

Parkinson's Disease and Risk of Falling: (Dennison et al, 2007; n = 23 fallers and 25 fallers)

Score on the SE-ADL did not discriminate between fallers and non-fallers

SE-ADL Scores among fallers and non-fallers:
Domain	Fallers	Non-fallers	p
Age (yrs)	73.96 (8.33)	75.16 (7.87)	0.69
Education (yrs)	14.39 (4.15)	12.28 (2.93)	0.10
Onset, Symptoms (mos)	135.68 (135.07)	87.28 (53.20)	0.25
Onset, Diagnosis (mos)	106.91 (87.73)	69.33 (43.76)	0.20
SE-ADL	73.06 (17.25)	80.65 (11.99)	0.17
Hoehn and Yahr (stage/5)	2.80 (0.70)	2.38 (0.56)	0.007
Mini-Mental Status Examination (Score/30)	25.83 (2.61)	27.05 (2.44)	0.18

Non-motor symptoms and Parkinson’s disease:(Kadastik-Eerme et al., 2015; n = 268; mean age = 74.2 (8.8) years; disease onset age = 66.8 (10.1) years; duration of disease = 7.6(5.9))

Moderate correlation was between SE-ADL and health related quality of life in PD patients
Health related quality of life was measured by the PDQ-39 (disease specific quality of life instrument)

Bibliography

Bertucci Filho, D., Teive, H. A., et al. (2007). "Early-onset Parkinson's disease and depression." Arq Neuropsiquiatr 65(1): 5-10. Find it on PubMed

Christ, J.B., Berger, M.F., Riedl, E., Prakash, D., Csoti, I., Molt, W.,… Liepelt-Scarfone, I. (2013). How precise are activities of daily living scales for the diagnosis of Parkinson’s disease dementia? A pilot study. Parkinsonism & Related Disorders, 19(3), 371-374.Find it on PubMed

Dal Bello-Haas, V., Klassen, L., et al. (2011). "Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease." Physiother Can 63(1): 47-57. Find it on PubMed

Dennison, A. C., Noorigian, J. V., et al. (2007). "Falling in Parkinson disease: identifying and prioritizing risk factors in recurrent fallers." American journal of physical medicine & rehabilitation 86(8): 621. Find it on PubMed

Hass, C.J., Bishop, M., Moscovich, M., Stegemöller, E.L., Skinner, J., Malaty, I.A.,… Okun, M.S. (2014). Defining the clinically meaningful difference in gait speed in persons with Parkinson disease. Journal of Neurologic Physical Therapy, 38(4). 233-238. Find it on PubMed

Kadastik-Eerme, L., Rosenthal, M., Paju, T., Muldmaa, M., & Taba, P. (2015). Health-related quality of life in Parkinson’s disease: A cross-sectional study focusing on non-motor symptoms. Health and Quality of Life Outcomes Health Quality Life Outcomes, 13(1). Find it on PubMed

McRae, C., Diem, G., et al. (2002). "Reliability of measurements of patient health status: a comparison of physician, patient, and caregiver ratings." Parkinsonism Relat Disord 8(3): 187-192. Find it on PubMed

Shulman, L. M., Gruber-Baldini, A. L., et al. (2010). "The clinically important difference on the unified Parkinson's disease ra

Last Updated

Purpose

Link to Instrument

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Cut-Off Scores

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Normative Data

Construct Validity

Bibliography

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