title: Unified Parkinson's Disease Rating Scale-Motor Exam: inter-rater reliability of advanced practice nurse and neurologist assessments.
abstract: OBJECTIVE
  This paper is a report of a study to establish the inter-rater reliability of advanced practice nurse and neurologist neurological assessments which included ratings with the Unified Parkinson's Disease Rating Scale-Motor Exam.
  
  
  BACKGROUND
  Around the world, advanced practice nurses are performing tasks once completed only by physicians. To promote consumer and provider confidence, it is important to establish that nurse and physician ratings using assessment tools are similar. In addition in research settings, when different raters are used, establishment of inter-rater reliability for study assessments is needed.
  
  
  METHODS
  Advanced practice nurses and neurologists independently recorded findings on neurological examinations of 46 participants in a study conducted between August 2007 and January 2008. An intraclass correlation coefficient was calculated to estimate overall agreement between the nurse and neurologist ratings. Agreement for individual items measured on a dichotomous scale was assessed by calculating Cohen's kappa.
  
  
  RESULTS
  There was substantial agreement between advanced practice nurses and neurologists on the mean Unified Parkinson's Disease Rating Scale-Motor Exam ratings (intraclass correlation coefficient = 0.65) and the U.S. National Alzheimer's Coordinating Center Uniform Data Set neurological examination ratings of unremarkable findings (kappa = 0.74) and of gait disorder (kappa = 0.73). Moderate agreement (kappa = 0.53) was reached for the rating of whether all Unified Parkinson's Disease Rating Scale-Motor Exam items were normal.
  
  
  CONCLUSIONS
  These findings are consistent with studies of the inter-rater agreement of the Unified Parkinson's Disease Rating Scale-Motor Exam and support the conduct of neurological assessments by advanced practice nurses.
authors.affiliation: Saint Louis University School of Nursing, St Louis, Missouri, USA. palmerjl@slu.edu
authors.forename: Janice L
authors.initials: JL
authors.lastname: Palmer
authors.forename: Mary A
authors.initials: MA
authors.lastname: Coats
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Roe
authors.forename: Shelly M
authors.initials: SM
authors.lastname: Hanko
authors.forename: Chengjie
authors.initials: C
authors.lastname: Xiong
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
mesh_terms: D004185:Disability Evaluation; D006801:Humans; D009043:Motor Activity / Q000502:physiology*; D009460:Neurologic Examination; D009462:Neurology; D015588:Observer Variation; D010300:Parkinson Disease / Q000175:diagnosis / Q000451:nursing / Q000503:physiopathology*; D057184:Practice Patterns, Nurses'; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013038:Specialization