Using Cognitive Pretesting in Scale Development for Parkinson's Disease: The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Example

Mar 12, 2014Journal of Parkinson's disease

Using thinking tests to improve the Parkinson’s disease movement rating scale

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Abstract

Two rounds of cognitive pretesting were necessary before field testing the revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

Cognitive pretesting evaluates respondent interest, attention span, discomfort, and comprehension.
Issues identified during pretesting included difficulties with question phrasing and logical structure.
Revisions to the scale involved simplifying questions and adding clarifications for respondents.
Incorporating cognitive pretesting into scale development may enhance understanding and usability.
The approach is also being applied to MDS-UPDRS translations and a new Unified Dyskinesia Rating Scale.

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BACKGROUND: Cognitive pretesting, a qualitative step in scale development, precedes field testing and assesses the difficulty of instrument completion for examiners and respondents. Cognitive pretesting assesses respondent interest, attention span, discomfort, and comprehension, and highlights problems with the logical structure of questions/response options that can affect understanding. In the past this approach was not consistently used in the development or revision of movement disorders scales.

METHODS: We applied qualitative cognitive pretesting using testing guides in development of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The guides were based on qualitative techniques, verbal probing and "think-aloud" interviewing, to identify problems with the scale from the patient and rater perspectives. English-speaking Parkinson's disease patients and movement disorders specialists (raters) from multiple specialty clinics in the United States, Western Europe and Canada used the MDS-UPDRS and completed the testing guides.

RESULTS: Two rounds of cognitive pretesting were necessary before proceeding to field testing of the revised scale to assess clinimetric properties. Scale revisions based on cognitive pretesting included changes in phrasing, simplification of some questions, and addition of a reassuring statement explaining that not all PD patients experience the symptoms described in the questions.

CONCLUSIONS: The strategy of incorporating cognitive pretesting into scale development and revision provides a model for other movement disorders scales. Cognitive pretesting is being used in translating the MDS-UPDRS into multiple languages to improve comprehension and acceptance and in the development of a new Unified Dyskinesia Rating Scale for Parkinson's disease patients.

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Using Cognitive Pretesting in Scale Development for Parkinson's Disease: The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Example

Abstract

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