1Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
2Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
3Department of Neurology, Chungnam National University Sejong Hospital, Sejong; Chungnam National University College of Medicine, Daejeon, Korea
4Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
5Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2021 The Korean Movement Disorder Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
The authors have no financial conflicts of interest.
Author Contributions
Conceptualization: Jee-Young Lee. Data curation: Ji-Hyun Choi, Jee-Young Lee. Formal analysis: Ji-Hyun Choi, Jee-Young Lee. Investigation: all authors. Methodology: Jee-Young Lee. Project administration: Jee-Young Lee. Resources: Jee-Young Lee, Chaewon Shin, Han-Joon Kim, Tae-Beom Ahn, Beomseok Jeon. Supervision: Jee-Young Lee, Tae-Beom Ahn, Beomseok Jeon. Validation: Ji-Hyun Choi, Jin Hee Im. Visualization: Ji-Hyun Choi, JeeYoung Lee. Writing—original draft: Ji-Hyun Choi. Writing—review & editing: Jee-Young Lee, Chaewon Shin, Han-Joon Kim, Tae-Beom Ahn, JongMin Kim, Beomseok Jeon.
Item |
Internal consistency |
Interrater reliability |
||||
---|---|---|---|---|---|---|
Corrected item total correlation | Cronbach’s alpha if item deleted | PD patients | Caregivers | Coefficient | ||
Item 1: | Difficulty in turning over or around in bed | 0.81 | 0.78 | 40 (64.5) | 35 (56.5) | 0.83 |
Item 2: | Supine position for most of the night | 0.34 | 0.84 | 34 (54.8) | 33 (53.2) | 0.97 |
Item 3: | Difficulty in getting out of bed, requiring several attempts to get out of bed | 0.70 | 0.80 | 45 (72.6) | 44 (71.0) | 0.96 |
Item 4: | Asking for help or holding onto bed rails to get out of bed | 0.76 | 0.79 | 39 (62.9) | 26 (41.9) | 0.54 |
Item 5: | Stiffness in trunk/back during the night or in the early morning | 0.47 | 0.82 | 26 (41.9) | 21 (33.9) | 0.76 |
Item 6: | Stiffness in legs or arms during the night or in the early morning | 0.46 | 0.82 | 34 (54.8) | 28 (45.2) | 0.74 |
Item 7: | Pain in legs or arms during the night or in the early morning | 0.40 | 0.83 | 21 (33.9) | 15 (24.2) | 0.69 |
Item 8: | Unable to take the first step as soon as getting out of bed due to freezing | 0.71 | 0.79 | 38 (61.3) | 38 (61.3) | 0.93 |
Item 9: | Dyskinesia during the night | 0.32 | 0.83 | 9 (14.5) | 11 (17.7) | 0.88 |
Item 10 | : Taking extra PD medication during the night to relieve nighttime symptoms | 0.12 | 0.84 | 5 (8.1) | 6 (9.7) | 0.90 |
Total nocturnal hypokinesia score | 0.83 | - | 4.69 ± 2.92 | 4.10 ± 2.83 | 0.95* |
Internal consistency based on the corrected item total correlation and Cronbach’s alpha coefficient if items were deleted for all PD patients (n = 108). Interrater reliability based on Cohen’s kappa coefficient for ordinal variables and
* intraclass correlation for continuous variables between PD patients (n = 62) and their caregivers (n = 62).
NHQ-K: Korean version of the Nocturnal Hypokinesia Questionnaire, PD: Parkinson’s disease.
Scores for independent variables |
Total PD patients (n = 108) |
Early-stage PD (H&Y 1–2) (n = 60) |
Advanced-stage PD (H&Y 3–4) (n = 32) |
||||
---|---|---|---|---|---|---|---|
β coefficient | p value | β coefficient | p value | β coefficient | p value | ||
MDS-UPDRS-I items | |||||||
Cognitive impairment (item 1) | 0.050 | 0.506 | -0.039 | 0.761 | 0.373 | 0.036 | |
Hallucinations and any psychosis (item 2) | 0.013 | 0.868 | -0.145 | 0.250 | 0.315 | 0.216 | |
Depressive mood (item 3) | 0.076 | 0.319 | 0.171 | 0.142 | 0.154 | 0.528 | |
Anxious mood (item 4) | 0.246 | 0.001* | 0.383 | < 0.001* | 0.470 | 0.007 | |
Apathy (item 5) | 0.230 | 0.002* | 0.444 | < 0.001* | 0.515 | 0.003* | |
Dopamine dysregulation syndrome (item 6) | 0.177 | 0.013 | 0.289 | 0.009 | 0.216 | 0.380 | |
Sleep problems (item 7) | 0.100 | 0.178 | 0.198 | 0.102 | 0.108 | 0.651 | |
Daytime sleepiness (item 8) | 0.073 | 0.296 | 0.146 | 0.211 | 0.135 | 0.492 | |
Pain and other sensations (item 9) | 0.185 | 0.015 | 0.201 | 0.072 | 0.264 | 0.280 | |
Urinary problems (item 10) | 0.171 | 0.024 | 0.141 | 0.282 | 0.402 | 0.064 | |
Constipation problems (item 11) | 0.201 | 0.008 | 0.098 | 0.404 | 0.140 | 0.506 | |
Light headedness on standing (item 12) | 0.108 | 0.125 | 0.084 | 0.470 | 0.138 | 0.480 | |
Fatigue (item 13) | 0.110 | 0.154 | 0.255 | 0.034 | 0.400 | 0.023 | |
MDS-UPDRS-III items | |||||||
Axial (items 1,10–13) | 0.269 | 0.022 | 0.274 | 0.026 | 0.356 | 0.398 | |
Bradykinesia (items 2, 4–9, 14) | 0.220 | 0.022 | 0.318 | 0.006 | 0.084 | 0.863 | |
Rigidity (item 3) | -0.101 | 0.289 | -0.055 | 0.718 | -0.091 | 0.758 | |
Tremor (items 15–18) | -0.072 | 0.391 | -0.188 | 0.174 | -0.045 | 0.689 | |
MDS-UPDRS-IV items | |||||||
Dyskinesias duration and disability (items 1,2) | 0.271 | < 0.001* | 0.060 | 0.651 | 0.355 | 0.116 | |
Off duration and disability (items 3,4) | 0.505 | < 0.001* | 0.394 | < 0.001* | 0.496 | 0.004* | |
Motor fluctuations (item 5) | 0.190 | 0.029 | 0.178 | 0.175 | 0.257 | 0.334 | |
Painful off dystonia (item 6) | 0.180 | 0.025 | 0.208 | 0.076 | 0.501 | 0.004* | |
K-PDQ-39 domains | |||||||
Mobility | 0.484 | < 0.001* | 0.434 | < 0.001* | 0.594 | < 0.001* | |
Activities of daily living | 0.310 | < 0.001* | 0.437 | < 0.001* | 0.500 | 0.004* | |
Emotional well-being | 0.324 | < 0.001* | 0.439 | < 0.001* | 0.617 | < 0.001* | |
Stigma | 0.302 | < 0.001* | 0.391 | < 0.001* | 0.403 | 0.022 | |
Social support | 0.164 | 0.018 | 0.370 | 0.001* | 0.090 | 0.668 | |
Cognition | 0.196 | 0.007 | 0.270 | 0.021 | 0.440 | 0.012 | |
Communication | 0.251 | 0.004* | 0.416 | 0.002* | 0.315 | 0.269 | |
Bodily discomfort | 0.308 | < 0.001* | 0.456 | < 0.001* | 0.381 | 0.031 | |
Summary index | 0.505 | < 0.001* | 0.638 | < 0.001* | 0.623 | < 0.001* |
Multivariable analysis for the NHQ-K score with the MDS-UPDRS and K-PDQ-39 scores after adjusting for confounding factors including age, sex, disease duration, K-MMSE, H&Y stage, MDS-UPDRS-III total score, and total LED.
* significant level after Bonferroni correction; p<0.0038 for the MDSUPDRS-I items, p<0.0125 for the MDS-UPDRS-III and IV items, and p<0.00625 for the K-PDQ-39 domains.
PD: Parkinson’s disease, MDS-UPDRS: Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, K-PDQ-39: Korean version of the 39-item Parkinson’s Disease Questionnaire, K-MMSE: Korean version of the Mini-Mental State Examination, H&Y stage: Hoehn and Yahr stage, LED: levodopa equivalent dose.
Comments on this article
Item | Internal consistency |
Interrater reliability |
||||
---|---|---|---|---|---|---|
Corrected item total correlation | Cronbach’s alpha if item deleted | PD patients | Caregivers | Coefficient | ||
Item 1: | Difficulty in turning over or around in bed | 0.81 | 0.78 | 40 (64.5) | 35 (56.5) | 0.83 |
Item 2: | Supine position for most of the night | 0.34 | 0.84 | 34 (54.8) | 33 (53.2) | 0.97 |
Item 3: | Difficulty in getting out of bed, requiring several attempts to get out of bed | 0.70 | 0.80 | 45 (72.6) | 44 (71.0) | 0.96 |
Item 4: | Asking for help or holding onto bed rails to get out of bed | 0.76 | 0.79 | 39 (62.9) | 26 (41.9) | 0.54 |
Item 5: | Stiffness in trunk/back during the night or in the early morning | 0.47 | 0.82 | 26 (41.9) | 21 (33.9) | 0.76 |
Item 6: | Stiffness in legs or arms during the night or in the early morning | 0.46 | 0.82 | 34 (54.8) | 28 (45.2) | 0.74 |
Item 7: | Pain in legs or arms during the night or in the early morning | 0.40 | 0.83 | 21 (33.9) | 15 (24.2) | 0.69 |
Item 8: | Unable to take the first step as soon as getting out of bed due to freezing | 0.71 | 0.79 | 38 (61.3) | 38 (61.3) | 0.93 |
Item 9: | Dyskinesia during the night | 0.32 | 0.83 | 9 (14.5) | 11 (17.7) | 0.88 |
Item 10 | : Taking extra PD medication during the night to relieve nighttime symptoms | 0.12 | 0.84 | 5 (8.1) | 6 (9.7) | 0.90 |
Total nocturnal hypokinesia score | 0.83 | - | 4.69 ± 2.92 | 4.10 ± 2.83 | 0.95 |
Scores for independent variables | Total PD patients (n = 108) |
Early-stage PD (H&Y 1–2) (n = 60) |
Advanced-stage PD (H&Y 3–4) (n = 32) |
||||
---|---|---|---|---|---|---|---|
β coefficient | p value | β coefficient | p value | β coefficient | p value | ||
MDS-UPDRS-I items | |||||||
Cognitive impairment (item 1) | 0.050 | 0.506 | -0.039 | 0.761 | 0.373 | 0.036 | |
Hallucinations and any psychosis (item 2) | 0.013 | 0.868 | -0.145 | 0.250 | 0.315 | 0.216 | |
Depressive mood (item 3) | 0.076 | 0.319 | 0.171 | 0.142 | 0.154 | 0.528 | |
Anxious mood (item 4) | 0.246 | 0.001 |
0.383 | < 0.001 |
0.470 | 0.007 | |
Apathy (item 5) | 0.230 | 0.002 |
0.444 | < 0.001 |
0.515 | 0.003 |
|
Dopamine dysregulation syndrome (item 6) | 0.177 | 0.013 | 0.289 | 0.009 | 0.216 | 0.380 | |
Sleep problems (item 7) | 0.100 | 0.178 | 0.198 | 0.102 | 0.108 | 0.651 | |
Daytime sleepiness (item 8) | 0.073 | 0.296 | 0.146 | 0.211 | 0.135 | 0.492 | |
Pain and other sensations (item 9) | 0.185 | 0.015 | 0.201 | 0.072 | 0.264 | 0.280 | |
Urinary problems (item 10) | 0.171 | 0.024 | 0.141 | 0.282 | 0.402 | 0.064 | |
Constipation problems (item 11) | 0.201 | 0.008 | 0.098 | 0.404 | 0.140 | 0.506 | |
Light headedness on standing (item 12) | 0.108 | 0.125 | 0.084 | 0.470 | 0.138 | 0.480 | |
Fatigue (item 13) | 0.110 | 0.154 | 0.255 | 0.034 | 0.400 | 0.023 | |
MDS-UPDRS-III items | |||||||
Axial (items 1,10–13) | 0.269 | 0.022 | 0.274 | 0.026 | 0.356 | 0.398 | |
Bradykinesia (items 2, 4–9, 14) | 0.220 | 0.022 | 0.318 | 0.006 | 0.084 | 0.863 | |
Rigidity (item 3) | -0.101 | 0.289 | -0.055 | 0.718 | -0.091 | 0.758 | |
Tremor (items 15–18) | -0.072 | 0.391 | -0.188 | 0.174 | -0.045 | 0.689 | |
MDS-UPDRS-IV items | |||||||
Dyskinesias duration and disability (items 1,2) | 0.271 | < 0.001 |
0.060 | 0.651 | 0.355 | 0.116 | |
Off duration and disability (items 3,4) | 0.505 | < 0.001 |
0.394 | < 0.001 |
0.496 | 0.004 |
|
Motor fluctuations (item 5) | 0.190 | 0.029 | 0.178 | 0.175 | 0.257 | 0.334 | |
Painful off dystonia (item 6) | 0.180 | 0.025 | 0.208 | 0.076 | 0.501 | 0.004 |
|
K-PDQ-39 domains | |||||||
Mobility | 0.484 | < 0.001 |
0.434 | < 0.001 |
0.594 | < 0.001 |
|
Activities of daily living | 0.310 | < 0.001 |
0.437 | < 0.001 |
0.500 | 0.004 |
|
Emotional well-being | 0.324 | < 0.001 |
0.439 | < 0.001 |
0.617 | < 0.001 |
|
Stigma | 0.302 | < 0.001 |
0.391 | < 0.001 |
0.403 | 0.022 | |
Social support | 0.164 | 0.018 | 0.370 | 0.001 |
0.090 | 0.668 | |
Cognition | 0.196 | 0.007 | 0.270 | 0.021 | 0.440 | 0.012 | |
Communication | 0.251 | 0.004 |
0.416 | 0.002 |
0.315 | 0.269 | |
Bodily discomfort | 0.308 | < 0.001 |
0.456 | < 0.001 |
0.381 | 0.031 | |
Summary index | 0.505 | < 0.001 |
0.638 | < 0.001 |
0.623 | < 0.001 |
Internal consistency based on the corrected item total correlation and Cronbach’s alpha coefficient if items were deleted for all PD patients ( intraclass correlation for continuous variables between PD patients ( NHQ-K: Korean version of the Nocturnal Hypokinesia Questionnaire, PD: Parkinson’s disease.
Multivariable analysis for the NHQ-K score with the MDS-UPDRS and K-PDQ-39 scores after adjusting for confounding factors including age, sex, disease duration, K-MMSE, H&Y stage, MDS-UPDRS-III total score, and total LED. significant level after Bonferroni correction; p<0.0038 for the MDSUPDRS-I items, p<0.0125 for the MDS-UPDRS-III and IV items, and p<0.00625 for the K-PDQ-39 domains. PD: Parkinson’s disease, MDS-UPDRS: Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, K-PDQ-39: Korean version of the 39-item Parkinson’s Disease Questionnaire, K-MMSE: Korean version of the Mini-Mental State Examination, H&Y stage: Hoehn and Yahr stage, LED: levodopa equivalent dose.