A letter by Christopher G. Goetz, Glenn T. Stebbins, and Sheng Luo published in Movement Disorders addresses use of the Unified Parkinson's Disease Rating Scale (UPDRS) via telemedicine during the COVID-19 pandemic when in-person visits to movement disorder specialists are limited and telemedicine has become more prevalent. In particular, this letter notes that the UPDRS cannot be used reliably via telemedicine because rigidity can not be measured without touch and postural reflexes can not be safely measured without trained medical personnel. Together, the measures of rigidity and postural reflexes comprise 6 missing values on the UPDRS, whereas it has previously been shown more than 3 consistenly missing values compromises the validity of a calibrated total score on the UPDRS.
The authors further note that the validity of the UPDRS was based on in-person visits and measurements, and that to their knowledge, there has been no validation of the use of this scale via video-enable teleneurology visits.
The authors conclude that although they are very comfortable providing video-based or teleneurology care of high quality and compassion for people with Parkinson's disease, they cannot recommend use of the UPDRS in this context. They instead refer colleagues to recommendations from the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to "be honest, humbly admit to our limitations, do our best, and document what we do."
Allie Massaro, MD
Jennifer Robblee, MD, MSc; Amaal J. Starling, MD; Rashmi B. Halker Singh, MD, FAHS, FAAN; and Nina Riggins, MD, PhD
Stephen M. Gollomp, MD, and Paul G. Mathew, MD, DNBPAS, FAAN, FAHS