title: Using cognitive pretesting in scale development for Parkinson's disease: the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) example.
abstract: BACKGROUND
  Cognitive pretesting, a qualitative step in scale development, precedes field testing and assesses the difficulty of instrument completion for examiners and respondents. Cognitive pretesting assesses respondent interest, attention span, discomfort, and comprehension, and highlights problems with the logical structure of questions/response options that can affect understanding. In the past this approach was not consistently used in the development or revision of movement disorders scales.
  
  
  METHODS
  We applied qualitative cognitive pretesting using testing guides in development of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The guides were based on qualitative techniques, verbal probing and "think-aloud" interviewing, to identify problems with the scale from the patient and rater perspectives. English-speaking Parkinson's disease patients and movement disorders specialists (raters) from multiple specialty clinics in the United States, Western Europe and Canada used the MDS-UPDRS and completed the testing guides.
  
  
  RESULTS
  Two rounds of cognitive pretesting were necessary before proceeding to field testing of the revised scale to assess clinimetric properties. Scale revisions based on cognitive pretesting included changes in phrasing, simplification of some questions, and addition of a reassuring statement explaining that not all PD patients experience the symptoms described in the questions.
  
  
  CONCLUSIONS
  The strategy of incorporating cognitive pretesting into scale development and revision provides a model for other movement disorders scales. Cognitive pretesting is being used in translating the MDS-UPDRS into multiple languages to improve comprehension and acceptance and in the development of a new Unified Dyskinesia Rating Scale for Parkinson's disease patients.
authors.affiliation: Division of Biostatistics, University of Texas School of Public Health at Houston, Houston, TX, USA.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Tilley
authors.affiliation: Division of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: LaPelle
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Goetz
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Stebbins
mesh_terms: D006801:Humans; D010300:Parkinson Disease / Q000175:diagnosis*; D012720:Severity of Illness Index; D012955:Societies, Medical / Q000592:standards*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Cognitive pretesting; Modified Unified Parkinson's Disease Rating Scale; Parkinson's disease; scale development