Gender-, age-, and race/ethnicity-based differential item functioning analysis of the movement disorder society-sponsored revision of the Unified Parkinson's disease rating scale.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVE: Assess MDS-UPDRS items for gender-, age-, and race/ethnicity-based differential item functioning. BACKGROUND: Assessing differential item functioning is a core rating scale validation step. For the MDS-UPDRS, differential item functioning occurs if item-score probability among people with similar levels of parkinsonism differ according to selected covariates (gender, age, race/ethnicity). If the magnitude of differential item functioning is clinically relevant, item-score interpretation must consider influences by these covariates. Differential item functioning can be nonuniform (covariate variably influences an item-score across different levels of parkinsonism) or uniform (covariate influences an item-score consistently over all levels of parkinsonism). METHODS: Using the MDS-UPDRS translation database of more than 5,000 PD patients from 14 languages, we tested gender-, age-, and race/ethnicity-based differential item functioning. To designate an item as having clinically relevant differential item functioning, we required statistical confirmation by 2 independent methods, along with a McFadden pseudo-R2 magnitude statistic greater than "negligible." RESULTS: Most items showed no gender-, age- or race/ethnicity-based differential item functioning. When differential item functioning was identified, the magnitude statistic was always in the "negligible" range, and the scale-level impact was minimal. CONCLUSIONS: The absence of clinically relevant differential item functioning across all items and all parts of the MDS-UPDRS is strong evidence that the scale can be used confidently. As studies of Parkinson's disease increasingly involve multinational efforts and the MDS-UPDRS has several validated non-English translations, the findings support the scale's broad applicability in populations with varying gender, age, and race/ethnicity distributions. © 2016 International Parkinson and Movement Disorder Society.

Full Text

Duke Authors

Cited Authors

  • Goetz, CG; Liu, Y; Stebbins, GT; Wang, L; Tilley, BC; Teresi, JA; Merkitch, D; Luo, S

Published Date

  • December 2016

Published In

Volume / Issue

  • 31 / 12

Start / End Page

  • 1865 - 1873

PubMed ID

  • 27943473

Pubmed Central ID

  • PMC5289884

Electronic International Standard Serial Number (EISSN)

  • 1531-8257

Digital Object Identifier (DOI)

  • 10.1002/mds.26847


  • eng

Conference Location

  • United States