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RehabMeasures Instrument

Parkinson’s Disease Questionnaire-8

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Purpose

The Parkinson’s Disease Questionaire-8 is a short-form version, derived from the Parkinson Disease Questionaire-39. It is a self-administered questionnaire, used to measure quality of life in persons with Parkinson’s disease.

Link to Instrument

Instrument details

Acronym PDQ-8

Area of Assessment

Activities of Daily Living
Attention & Working Memory
Communication
Depression
Quality of Life
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

See more information here: https://innovation.ox.ac.uk/outcome-measures/parkinsons-disease-questionnaire-pdq-39-pdq-8/

Diagnosis/Conditions

  • Parkinson's Disease & Neurologic Rehabilitation

Key Descriptions

  • The Parkinson’s Disease Questionnaire-8 is derived from the PDQ-39.
  • One question from each of the 8 domains on the PDQ-39 (mobility, ADLs, emotional well-being, stigma, social support, cognitions, communication, and bodily discomfort) was chosen based on the strength of its correlation with the total domain score.
  • Each question is scored from 0-4 points and the scores are summed.
  • The summed score is then divided by total possible score and given as a percentage score out of 100.

Number of Items

8

Equipment Required

  • Paper copy of PDQ-8
  • Pencil/ Pen

Time to Administer

5-12 minutes

(Huang et al, 2010)

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Terry Ellis, DPT, PhD; NCS; Laura Savella sPT & the PD EDGE Task Force of the Neurology Section of the APTA

ICF Domain

Participation

Measurement Domain

General Health

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

HR

HR

HR

HR

HR

 

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

Yes

Yes

Yes

Not reported

Considerations

Many studies do not specify number of participants in each H&Y stage but report the mean H&Y stage, making classifying evidence by stage alone difficult. The majority of evidence supporting the use of this measure is for persons in H&Y Stages 2-3.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us

Parkinson's Disease

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Minimally Clinically Important Difference (MCID)

Parkinson’s Disease: 

(Luo et al, 2009; = 96, mean age = 58.4(8.8), H&Y Stage: 1, = 3; 2, = 72; 2.5 = 15, 3, = 6, 4:= 0; Tertiary neuroscience clinic in Singapore) 

  • Anchor based Minimally Important Difference range over 1 year: 5.78-7.4 points 
    • The mean change (95% CI) in PDQ-8SI scores for (n = 28) patients who reported that their overall health status was ‘‘a little worse’’ than 1 year ago = 7.37 (0.09, 14.64) 
    • The mean change (95% CI) in PDQ-8SI scores for (n = 28) patients who reported that their PD severity was ‘‘a little worse’’ = 5.78 (20.54, 12.09) 
    • The mean change (95% CI) in PDQ-8SI scores for (n = 23) patients who reported that the impact of PD on their life was ‘‘a little greater,’’ the mean change (95% CI) = 6.79 (20.26, 13.85)

Normative Data

Parkinson’s Disease:

(Jenkinson et al, 1997; Survey Group 1: = 227, mean age = 70(9); Survey Group 2: = 359, no data on age) 

Combined groups subset: Mean PDQ-8 Scores by Stage: 

  • H&Y I: = 37, Mean score = 17.74(16.27) 
  • H&Y II: = 58, Mean score = 33.14(18.80) 
  • H&Y III: = 21, Mean score = 37.05(22.05) 
  • H&Y IV: = 19, Mean score = 47.86(16.17)

Test/Retest Reliability

Parkinson’s Disease:

(Katsauou et al, 2004; = 228; mean age = 59.3(8.7); H&Y stage: I: = 22; II: = 103; III: = 31, IV: = 42; Greek OP PD & movement disorders unit) 

  • ICC = 0.72 

 

(Luo et al, 2009; taken median 1.7 years apart) 

  • ICC = 0.75; calculated for pts reporting “no change in health status 
  • ICC = 0.76; calculated for pts reporting “no change in PD severity” 
  • ICC = 0.64; calculated for pts reporting “no change in PD impact

Interrater/Intrarater Reliability

Parkinson’s Disease: 

(Huang et al, 2010; = 100; mean age = 62.04(11.33); mean H&Y Stage = 2.21(1.18); Taiwanese movement disorders unit) 

  • Excellent inter-rater reliability for 10 consecutive subjects (ICC = 1)

Internal Consistency

Parkinson’s Disease: 

(Jenkinson et al, 2007; = 819; mean age = 68.35(9.49); mean H&Y stage = varies by country) 

  • USA: = 185, H&Y Stage = 2.54(0.88) 
    • Excellent (Cronbach a = 0.88) 
  • Japan: = 100, H&Y Stage = 2.85(0.95) 
    • Adequate (Cronbach a = 0.73) 
  • Canada: = 126, H&Y Stage = 2.65(1.03) 
    • Excellent (Cronbach a = 0.83) 
  • Italy: = 205, H&Y Stage = 2.45(1.09) 
    • Excellent (Cronbach a = 0.87) 
  • Spain: = 200, H&Y Stage = 2.47(1.09) 
    • Adequate (Cronbach a = 0.79) 

 

(Tan et al, 2004; = 68; mean age = 63.1(9.6); no age/H&Y stage reported;English speaking Singapore sample) 

  • Adequate (Cronbach a = 0.75) 

 

(Tan et al, 2007; English speaking: = 104;mean age = 59.9(9.8); mean H&Y stage = 2.3(0.7); Chinese speaking; = 79; mean age = 62.5(9.7); mean H&Y stage = 2.3(0.7); English and Chinese speaking pts in Singapore) 

  • Excellent (Cronbach a = 0.81); English Speaking 
  • Excellent (Cronbach a = 0.87); Chinese Speaking 

 

(Huang et al, 2010) 

  • Excellent (Chronbach’s a = 0.81) 

 

(Frannchignoni et al, 2008; = 200; mean age = 72(7); years of disease = 7(5) median H&Y stage = 3; Italian sample 

  • Adequate (Cronbach a = 0.72) 

 

(Caap-Ahlgren M, Dehlin O, 2004; = 91; mean age = 70(5), mean duration of PD = 10 (range 2-35); H&Y Stages 1-5 represented) 

  • Adequate (Cronbach a = 0.74)

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease:

Concurrent Validity PDQ-8 & PDQ-39: 

(Jenkinson et al, 1997) 

  • Excellent (r = 0.96); = 459 

 

(Jenkinson & Fitzpatrick, 2007) 

  • USA, = 178 
    • Excellent (Spearman’s rho = 0.96) 
  • Japan, = 97 
    • Excellent (Spearman’s rho = 0.92) 
  • Canada, = 124 
    • Excellent (Spearman’s rho = 0.96) 
  • Italy, = 195 
    • Excellent (Spearman’s rho = 0.96) 
  • Spain, = 194 
    • Excellent (Spearman’s rho = 0.93) 

 

(Tan et al, 2004) 

  • Excellent (Pearson’s r = 0.96) 
  • Excellent (ICC = 0.95)

Construct Validity

Parkinson’s Disease

(Jenkinson & Fitzpatrick, 2007; convergent validity with H&Y Stages) 

  • USA, = 178 
    • Adequate (Spearman correlation = 0.51) 
  • Japan, = 96 
    • Adequate (Spearman correlation = 0.47) 
  • Canada, = 119 
    • Adequate (Spearman correlation = 0.51) 
  • Italy, = 195 
    • Adequate (Spearman correlation = 0.47) 
  • Spain, = 194 
    • Excellent (Spearman correlation = 0.61) 

 

(Jenkinson et al, 1997) 

Convergent validity with Columbia rating scale 

  • Adequate (r = 0.47); n = 135 

 

(Martinez-Martin et al, 2005; = 57 caregiver-subject pairs; mean age PD = 67.01(6.16); mean H&Y Stage = 2.60(0.74)) 

Convergent validity with PDQ-8 by proxy 

  •  Excellent (ICC = 0.77-0.82) 

 

(Tan et al, 2007; Convergent validity with PD disease duration, H&Y Stage, UPDRS motor score)

  • English speaking 
    • Long history of PD: Adequate (correlation coefficient = 0.39) 
    • Higher H&Y Stage: Adequate (correlation coefficient = 0.38)
    • Higher UPDRS motor score: Adequate (correlation coefficient = 0.39) 
  • Chinese speaking 
    • Long history of PD: Poor (correlation coefficient = 0.17) 
    • Higher H&Y Stage: Poor (correlation coefficient = 0.29) 
    • Higher UPDRS motor score: Poor (correlation coefficient = 0.25) 

 

(Huang et al, 2010; Convergent validity with PD disease duration, H&Y Stage, UPDRS motor, ADL, and mental scores)

  • Long disease duration: Adequate (correlation coefficient) = 0.43 
  • Higher H&Y Stage: Adequate (correlation coefficient = 0.53) 
  • Higher UPDRS motor score: Adequate (correlation coefficient = 0.47) 
  • Higher UPDRS mental score: Adequate (correlation coefficient = 0.52) 
  • Higher UPDRS ALD score: Excellent (correlation coefficient = 0.60) 

 

(Caap-Ahlgren M, Dehlin O, 2004) 

Convergent validity of the PDQ-8 with: 

  • Hoehn & Yahr Stage: Adequate (Spearman correlation = 0.52) 
  • SF-36: Excellent (Spearman correlation = 0.72) 
  • Geriatric Depression Scale: Excellent (Spearman correlation = 0.66) 
  • Insomnia: Adequate (Spearman correlation = 0.42) 
  • Sense of Coherence (SOC) Scale: Adequate(Spearman correlation = 0.53)

Floor/Ceiling Effects

Parkinson’s Disease:

No studies have found floor or ceiling effects in this measure 

(Jenkinson et al, 2007) 

  • No ceiling/floor effects: n = 25(3.05%) scored 0 (min); n = 2(0.24%) scored 100(max) 

 

(Tan et al, 2007) 

  • No ceiling/floor effects 

 

(Huang et al, 2010; = 100; mean age = 62.04(11.33); mean H&Y stage = 2.21(1.18); Taiwanese movement disorders unit 

  • No ceiling/floor effects: n = 12 scored < 5; n = 1 scored  > 95 

 

(Frannchignoni et al, 2008) 

  • No ceiling/floor effects: n = 2 scored 0 (min); n = 0 scored 100 (max)

Responsiveness

Parkinson’s Disease:

(Luo et al, 2010; = 31; mean age = 60.6(10); H&Y Scale, baseline = 2.09(0.38); H&Y Scale, follow-up = 2.40(0.7); 4 years follow-up 

  • Large responsiveness (Effect Size (ES) = 1.22) 
  • SRM = 0.89 

 

(Luo et al, 2009; taken median 1.7 years apart) 

  • Pt reported perceived health status change: 
    • Better: Effect size (ES) = 0.40 
    • Worse: Effect size (ES) = 0.32 
    • Same: Effect size (ES) = 0.08
  •  Pt reported perceived PD Severity change: 
    • Better: Effect size (ES) = 0.40 
    • Worse: Effect size (ES) = 0.27 
    • Same: Effect size (ES) = 0.05 
  • Pt reported perceived PD Impact change: 
    • Better: Effect size (ES) = 0.39 
    • Worse: Effect size (ES) = 0.23 
    • Same: Effect size (ES) = 0.10 

 

(Laupheimer M, Schmidt K, 2011.) 

Responsiveness to Exercise Intervention 

  • Intervention group : n = 21, mean age = 67.5(7.8), mean disease duration = 7.2(5.6), mean H&Y Stage = 2.69(0.75); 10 week FE cycling program with motor assisted therapy device 
  • Control group : = 23, mean age = 71.3(4.0), mean disease duration = 11.0(7.2), mean H&Y Stage = 2.7(0.63) 
    • Changes approached significance for questions #2 and #3: “dressing” (F = 2.60; p = 0.09; p.Eta² = 0.058) and “depressions” (F = 2.92; p = 0.06; p.Eta² = 0.065). 
    • There were no significant trends for questions #1 and #4-10: “appearance in public,” “personal contacts,” “concentration,” “communication,” “muscle tensions,” and “embarrassment” 

 

(Onofrj et al, 2004: Entacapone intervention (3, 4, or 5 doses daily) N = 896, mean age = 69.8(9.3), mean duration of PD = 7.9(5.2)) 

Responsiveness to Pharmacological Intervention 

  • Overall mean reduction (improvement) in PDQ-8 score from baseline across 3 treatment groups = 1.8 points (95%-CI: [1.5, 2%]) 
  • By dosage group: 
    • 3 dose daily (n = 350): Mean reduction (improvement)[95% CI] = 1.5 points [1.1,2.0] 
    • 4 dose daily (= 330): Mean reduction (improvement)[95% CI] = 1.8 [1.4,2.3] 
    • 5 dose daily (= 216): Mean reduction (improvement)[95% CI] = 2.0 [1.5,2.0] 
    • Intergroup comparison showed there was no statistically significant difference in benefit in QoL between the three different dose regimen groups. 

 

(Fung et al, 2009; = 184, mean age = 63.9(9.87), mean duration of PD = 3.7(3.08), H&Y Stages 1-2.5 ) 

  • Levodopa/Carbidopa/Entacapone (L/C/E) intervention group, (= 93): Mean reduction (improvement) of PDQ-8 Score = 0.8 points 
  • Levodopa/Carbidopa (L/C) intervention group (= 91): Mean increase (worsening) of PDQ-8 Score = 0.6 points 
  • The 1.4 point difference between the 2 groups (L/C/E and L/C) was statistically significant (p = 0.021) 
  • A treatment effect was noted at the individual questions level, which favored the L/C/E group in all 8 questions 
  • Statistically significant differences in mean change were seen for questions #3 (depression, P = 0.025), #4 (close personal relationships, P = 0.037), #6 (communication; P = 0.007), and #8 (social stigma, P = 0.033). 
  • Difference in mean change of question #2 (dressing) approached significance (P = 0.056) 
  • Differences in mean change for questions #1 (mobility), #5 (concentration), and #7 (muscle cramps or spasms) were not statistically significant. 

 

(Honig et al, 2009; = 22 patients with advanced PD, mean age = 58.6(9.1), mean duration of PD = 15.3(5.9), H&Y Stages: H&Y 1 = 0, H&Y 2 = 1, H&Y 2.5 = 1, H&Y 3 = 6, H&Y 4 = 10, H&Y 5 = 4; mean duration of L-dopa infusion treatment 6.7(2.8 months)) 

  • Baseline mean PDQ-8 scores = 44.2(18.4) and follow-up mean PDQ-8 scores = 20.7 ± 12.0) 
  • Mean change in PDQ-8 score = 23.4 points (p = 0.0003) 
  • Relative change in score = –53% 
  • ES (Large) = 1.3

Bibliography

Caap‐Ahlgren, M. and Dehlin, O. (2004). "Sense of coherence is a sensitive measure for changes in subjects with Parkinson's disease during 1 year." Scandinavian Journal of Caring Sciences 18(2): 154-159.  

Franchignoni, F., Giordano, A., et al. (2008). "Rasch analysis of the short form 8-item Parkinson's Disease Questionnaire (PDQ-8)." Qual Life Res 17(4): 541-548. Find it on PubMed

Fung, V. S., Herawati, L., et al. (2009). "Quality of life in early Parkinson's disease treated with levodopa/carbidopa/entacapone." Mov Disord 24(1): 25-31. Find it on PubMed

Honig, H., Antonini, A., et al. (2009). "Intrajejunal levodopa infusion in Parkinson's disease: a pilot multicenter study of effects on nonmotor symptoms and quality of life." Mov Disord 24(10): 1468-1474. Find it on PubMed

Huang, T. T., Hsu, H. Y., et al. (2011). "Quality of life in Parkinson's disease patients: validation of the Short-Form Eight-item Parkinson's Disease Questionnaire (PDQ-8) in Taiwan." Qual Life Res 20(4): 499-505. Find it on PubMed

Jenkinson, C. and Fitzpatrick, R. (2007). "Cross-cultural evaluation of the short form 8-item Parkinson's Disease Questionnaire (PDQ-8): results from America, Canada, Japan, Italy and Spain." Parkinsonism Relat Disord 13(1): 22-28. Find it on PubMed  

Jenkinson, C., Fitzpatrick, R., et al. (1997). "The PDQ-8: development and validation of a short-form Parkinson's disease questionnaire." Psychology and Health 12(6): 805-814. 

Katsarou, Z., Bostantjopoulou, S., et al. (2004). "Assessing quality of life in Parkinson's disease: Can a short‐form questionnaire be useful?" Movement disorders 19(3): 308-312. 

Laupheimer, M., Härtel, S., et al. (2011). "Forced Exercise-effects of MOTOmed® therapy on typical motor dysfunction in Parkinson’s disease." 

Luo, N., Tan, L. C., et al. (2009). "Determination of the longitudinal validity and minimally important difference of the 8-item Parkinson's Disease Questionnaire (PDQ-8)." Mov Disord 24(2): 183-187. Find it on PubMed

Martinez-Martin, P., Benito-Leon, J., et al. (2005). "Quality of life of caregivers in Parkinson's disease." Qual Life Res 14(2): 463-472. Find it on PubMed

Onofrj, M., Thomas, A., et al. (2004). "Combining entacapone with levodopa/DDCI improves clinical status and quality of life in Parkinson’s Disease (PD) patients experiencing wearing-off, regardless of the dosing frequency: results of a large multicentre open-label study." Journal of neural transmission 111(8): 1053-1063. 

Tan, L., Lau, P. N., et al. (2007). "Validation of PDQ-8 as an independent instrument in English and Chinese." Journal of the neurological sciences 255(1): 77-80. 

Tan, L. C., Luo, N., et al. (2004). "Validity and reliability of the PDQ-39 and the PDQ-8 in English-speaking Parkinson's disease patients in Singapore." Parkinsonism Relat Disord 10(8): 493-499. Find it on PubMed 15542010

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