Category: Rating Scales
Objective: To quantify the use and variation of the motor part of Unified Multiple System Rating Scale (UMSARS II) on prospectively planned studies.
Background: Despite its availability for nearly 20 years, many studies including patients with multiple system atrophy (MSA) still use scales developed to assess ataxia (ATX) or parkinsonism (PARK), but the extent to which this occurs remains uncertain.
Method: Structured, PRISMA-compliant literature search on clinical studies including patients with MSA and motor assessment using clinical rating scales for MSA (UMSARS), for ATX (e.g., ICARS, SARA), or for PARK (MDS-UPDRS, UPDRS). We classified studies according to design in experimental/interventional or observational, and prospective or retrospective, and compared UMSARS use between each category; then, we compared the frequency of UMSARS use considering two research milestones: the publication of the Second consensus statement on diagnosis of MSA (2nd consensus) and the establishment of Movement Disorders Society MSA Study Group (MoDiMSA).
Results: We included 261 articles, most frequently of prospective (233, 89.3%) and observational (221, 87.4%) design. Scales used were UMSARS in 149 (57.1%), PARK in 67 (25.7%), ATX in 27 (10.3%), both PD and ATX in 16 (6.1%), and other scales in 2 (0.8%). We found UMSARS use to be higher in prospective (94.0% vs 83.0%, p<0.01), lower in retrospective (6.0% vs 17.0%, p<0.01), and similar in experimental (15.4% vs 15.2%, p>0.05) and observational (84.6% vs 84.8, p>0.05). Use of UMSARS was significantly higher in studies including only patients with MSA (71.1% vs 23.2%, p<0.001), whereas it was lower in studies including patients with disorders other than MSA, as parkinsonism (26.2% vs 58.0%, p<0.01) and ataxia (2.0% vs 17.0%, p<0.01). We found an increase in the rate of UMSARS use after the 2nd consensus (25.0% vs 60.5%, p<0.01) and the establishment of MoDiMSA (38.3% vs 62.2%, p<0.05), with decrease in the use of other scales, significant only for PD scales after 2nd consensus (57.1% vs 21.9%, p<0.01).
Conclusion: Although UMSARS use has greatly increased since its publication, misuse of PARK and ATX related scales in MSA patients persists in prospectively planned trials. This under-application of the scale could be overcome by joint efforts on promoting its use.
References:  Wenning GK, Tison F, Seppi K, et al. Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord 2004;19(12):1391-1402.
 Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology 2008;71(9):670-676.
 Fanciulli A, Stankovic I, Krismer F, Seppi K, Levin J, Wenning GK. Multiple system atrophy. Int Rev Neurobiol 2019;149:137-192.
To cite this abstract in AMA style:A. Ferreirós, S. Castillo-Torres, M. Merello. Use and Misuse of the Unified Multiple System Atrophy Rating Scale [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/use-and-misuse-of-the-unified-multiple-system-atrophy-rating-scale/. Accessed September 22, 2023.
« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/use-and-misuse-of-the-unified-multiple-system-atrophy-rating-scale/