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Validation Study of the Official Korean Version of the Movement Disorder Society-Unified Parkinson’S Disease Rating Scale

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Validation Study of the Official Korean Version of the Movement Disorder Society-Unified Parkinson’S Disease Rating Scale JCN Open Access ORIGINAL ARTICLE pISSN 1738-6586 / eISSN 2005-5013 / J Clin Neurol 2020;16(4):633-645 / https://doi.org/10.3988/jcn.2020.16.4.633 Validation Study of the Official Korean Version of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Jinse Parka, Seong-Beom Kohb, Kyum-Yil Kwonc, Sang Jin Kimd, Jae Woo Kime, Joong-Seok Kimf, Kun-Woo Parkg, Jong Sam Paikh, Young H. Sohni, Jin-Young Ahnj, Eungseok Ohk, Jinyoung Younl, Ji-Young Leem, Phil Hyu Leei, Wooyoung Jangn, Han-Joon Kimo, Beom Seok Jeono, Sun Ju Chungp, Jin Whan Chol, Sang-Myung Cheone, Suk Yun Kangq, Mee Young Parkr, Seongho Parka, Young Eun Huhs, Seok Jae Kangt, Hee-Tae Kimt aDepartment of Neurology, Inje University, Haeundae Paik Hospital, Busan, Korea bDepartment of Neurology, Korea University Guro Hosipital, Korea University College of Medicine, Seoul, Korea cDepartment of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea dDepartment of Neurology, Inje University Busan Paik Hospital, Busan, Korea eDepartment of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea fDepartment of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea gDepartment of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea hDepartment of Neurology, Inje University Sanggye Paik Hospital, Seoul, Korea iDepartment of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea jDepartment of Neurology, Seoul Medical Center, Seoul, Korea kDepartment of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea lDepartment of Neurology, Samsung Medical center, Sungkyunkwan University School of Medicine, Seoul, Korea mDepartment of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Korea nDepartment of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea oDepartment of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea pDepartment of Neurology, University of Ulsan College of Medicine, Asan Medical center, Seoul, Korea qDepartment of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea rDepartment of Neurology, College of Medicine, Yeungnam University, Daegu, Korea sDepartment of Neurology, CHA University Bundang Medical Center, CHA University, Seongnam, Korea tDepartment of Neurology, Hanyang University College of Medicine, Seoul, Korea Background and Purpose The Movement Disorder Society-Sponsored Revision of the Uni- fied Parkinson’s Disease Rating Scale (MDS-UPDRS) is widely used for estimating the symp- toms of Parkinson’s disease. Translation and validation of the MDS-UPDRS is necessary for non-English speaking countries and regions. The aim of this study was to validate the Korean version of the MDS-UPDRS. Methods Altogether, 362 patients in 19 centers were recruited for this study. We translated the MDS-UPDRS to Korean using the translation-back translation method and cognitive pre- testing. We performed both confirmatory and exploratory factor analyses to validate the scale. We calculated the comparative fit index (CFI) for confirmatory factor analysis, and used un- weighted least squares for exploratory factor analysis. Received April 29, 2020 Revised July 3, 2020 Results The CFI was higher than 0.90 for all parts of the scale. Exploratory factor analysis Accepted July 6, 2020 also showed that the Korean MDS-UPDRS has the same number of factors in each part as the Correspondence English version. Hee-Tae Kim, MD Conclusions The Korean MDS-UPDRS has the same overall structure as the English MDS- Department of Neurology, UPDRS. Our translated scale can be designated as the official Korean MDS-UPDRS. Hanyang University College of Medicine, Key Words ‌Parkinson’s diease, Movement Disorder Society Sponsored Revision of the 222-1 Wangsimni-ro, Seongdong-gu, Unified Parkinson’s Disease Rating Scale, validation, rating scale. Seoul 04763, Korea Tel +82-2-2290-8371 cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Com- Fax +82-2-2296-8370 mercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial E-mail [email protected] use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2020 Korean Neurological Association 633 JCN Validation of the Korean MDS-UPDRS INTRODUCTION METHODS Parkinson’s disease (PD) is characterized by various motor Study design and nonmotor symptoms and is the second most common This validation style had an observational, cross-sectional de- neurodegenerative disease. Estimating the severity of PD is sign. Translation of the MDS-UPDRS into Korean was per- challenging due to the heterogenic nature of its clinical pre- formed in three stages: 1) translation and back-translation, sentation, which includes motor and nonmotor symptoms as 2) cognitive pretesting, and 3) large-scale validation testing. well as motor complications. PD severity could only be assessed Stages 1 and 2 were performed by a task force comprising the in interviews and using a clinical scale to evaluate the abili- Korean Movement Disorder Society in collaboration with ties to perform simple tasks. The Unified Parkinson’s Disease the MDS. For stage 3, we enrolled 362 native-Korean-speak- Rating Scale (UPDRS) was introduced in the 1980s and has ing PD patients selected from 17 centers in Korea to perform become the most commonly used clinical scale for estimat- both confirmatory factor analysis (CFA) and exploratory ing the motor and nonmotor symptoms of PD patients.1 In factor analysis (EFA) for the validation. We also evaluated the 2001, a taskforce sponsored by the Movement Disorder So- internal consistency to determine the reliability of the scale ciety (MDS) highlighted some limitations and strengths of using Cronbach’s alpha coefficient. This study was approved the UPDRS.2 A new version of the UPDRS was proposed, by the Institutional Review Board at each center, and all par- with the revised scale called the Movement Disorder Society ticipants provided written informed consent (IRB no.: HY Sponsored Revision of the Unified Parkinson’s Disease Rat- 2014-02-002-008). ing Scale (MDS-UPDRS).3 The MDS-UPDRS includes the strengths of the UPDRS and improves its many drawbacks, Stage 1: translation protocol and shows acceptable validity and reliability.4 The MDS-UP- We translated the original MDS-UPDRS into Korean using DRS is currently the official clinical scale used to analyze symp- the translation–back-translation method. The two teams toms of PD, and it has been widely used in research and clini- that independently performed translation and back-trans- cal settings. lation consisted of members of the Korean Movement Disor- The MDS-UPDRS comprises four parts. Part I (nonmotor der Society. All members of the teams were experts in move- aspects of experiences of daily living) and part II (motor as- ment disorders, and at least one investigator on each team pects of experiences of daily living) comprise questionnaires was fluent in English. The translation team first translated that should be completed by patients or caregivers, and so it the original MDS-UPDRS into Korean, and then the back- is crucial that simple and common expressions are used in translation team retranslated the Korean MDS-UPDRS into parts I and II to obtain accurate information. The use of eas- English. These translation and retranslation processes were ily understood expressions in part III (motor examination) performed blindly. After finishing the translation–retransla- and part IV (motor complications) of the MDS-UPDRS is also tion processes, the teams compared the Korean MDS-UPDRS important for translation and validation purposes. These with the original English version and corrected mismatches. parts are used by general clinicians and movement experts for clinical and research purposes. Stage 2: cognitive pretesting The MDS-UPDRS has been translated and validated in Cognitive pretesting is a qualitative approach to assessing in- many countries after considering language and culture dif- strument usability (or ease of completion) in terms of task ferences, including into language version for Italian, Chinese, difficulty for both the examiner and respondent. This pretest- Dutch, German, French, Hebrew, Japanese, and Korean. The ing method also assesses the interest, attention span, discom- Italian, Hebrew, and Japanese versions of the MDS-UPDRS fort, and comprehension of the respondents.10 Ten PD patients have demonstrated validity and reliability.5-7 and three raters were interviewed, and a scale from 1 point to The prevalence of PD among the older population above 6 points was used to rate the difficulty during cognitive pretest- 60 years is 1.4% in Korea, and this is increasing more rapidly ing. When differences were observed between the back-trans- than the crude prevalence rate.8 Public awareness of the roles lated Korean version and the original English version of the of age and education level in the prevalence of PD in Korea is MDS-UPDRS, items and questions that were identified as po- also increasing, and the demand for using the MDS-UPDRS tentially
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