Objective: To explore the relationship and rate of agreement between patient and clinician evaluation of dyskinesia severity and impact on function across multiple cultures.

Background: Patients often perceive dyskinesia differently than clinicians. Differential effects of age, education, race and gender on items of the Unified Dyskinesia Rating Scale (UDysRS) have been examined. However, the effect of culture, as represented by language, on the relationship between the patient’s perception and clinician’s rating of dyskinesia has not been studied.

Method: The dataset included 4134 complete UDysRS scales from the MDS UDysRS Translation project. 16 different languages contributed a minimum of 250 cases to the database. We examined the relationship of subjective ratings of dyskinesia impact on function (UDysRS Part 1B) and clinician examination of dyskinesia severity (UDysRS Parts 3 and 4) for each language by calculating the ratio of subjective scores to objective scores and assessing intraclass correlation coefficients for rate of agreement. Post-hoc comparisons across the language ratios were run using a Scheffe correction for multiple comparisons. We included only patients with objective scores greater than 0.

Results: 3623 subjects were analyzed. Mean ratios of subjective to objective scores ranged from a high of 2.17 for the Chinese language to a low of 0.72 for the Korean sample. The ratio of subjective to objective scores for Chinese was significantly higher compared to all other languages. The ratio for Korean was significantly lower compared to German, Turkish, Greek, Polish and Finnish (all corrected p’s < 0.018). Intraclass correlation coefficients ranged from a high of 0.851 for Greek to a low of 0.360 for Chinese.

Conclusion: Patients’ perception of their dyskinesia may be different than clinicians’ ratings.  The results of this study suggest that culture, as represented by language, may play a part in this discrepancy.  Further work using other measures of both subjective and objective measures is underway.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-influence-of-culture-on-the-relationship-between-subjective-and-objective-assessments-of-dyskinesia-severity/