Category: Rating Scales
Objective: The aim of this study was to determine imputation accuracy for total-sum and item-specific MDS-UPDRS Part III (Motor Examination) scores in remote administration.
Background: Telemedicine has become standard in clinical care and research during the COVID-19 pandemic. Remote administration of MDS-UPDRS Motor Examination precludes ratings of all items, because Rigidity and Postural Stability (six scores) require in-person rating.
Method: We applied Multivariate Imputation by Chained Equations (MICE) techniques in a cross-sectional dataset where patients had one MDS-UPDRS rating (International Translational Program, n=8,588) and in a longitudinal dataset where patients had multiple ratings (Rush Program, n=396). Successful imputation was stringently defined as 1) generalized Lin’s Concordance Correlation Coefficient (CCC)>0.95, reflecting near-perfect agreement between total-sum score with complete data and surrogate score, calculated without patients’ actual Rigidity and Postural Stability scores, and 2) perfect agreement for item-level scores for Rigidity and Postural stability items.
Results: For total sum score when Rigidity and Postural Stability scores were withdrawn, using one or multiple visits, MICE imputation reached near-perfect agreement with the original total-sum score. However, at the item-level, the degree of perfect agreement between the surrogate and actual Rigidity items and Postural Stability scores always fell below threshold.
Conclusion: The MDS-UPDRS Part III total-sum score, a key clinical outcome in research and in clinical practice, can be accurately imputed without the Rigidity and Postural Stability items that cannot be rated by telemedicine. No formula, however, allows for specific item-level imputation. When Rigidity and Postural Stability item scores are of key clinical or research interest, PD patients must be scored in-person.
To cite this abstract in AMA style:
S. Luo, C. Goetz, D. Choi, S. Aggarwal, T. Mestre, G. Stebbins. Resolving missing data from the MDS-UPDRS: implications for telemedicine [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/resolving-missing-data-from-the-mds-updrs-implications-for-telemedicine/. Accessed June 15, 2025.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/resolving-missing-data-from-the-mds-updrs-implications-for-telemedicine/