Validity and reliability of a new tool to evaluate handwriting difficulties in Parkinson’s disease

BackgroundHandwriting in Parkinson’s disease (PD) features specific abnormalities which are difficult to assess in clinical practice since no specific tool for evaluation of spontaneous movement is currently available.ObjectiveThis study aims to validate the ‘Systematic Screening of Handwriting Difficulties’ (SOS-test) in patients with PD.MethodsHandwriting performance of 87 patients and 26 healthy age-matched controls was examined using the SOS-test. Sixty-seven patients were tested a second time within a period of one month. Participants were asked to copy as much as possible of a text within 5 minutes with the instruction to write as neatly and quickly as in daily life. Writing speed (letters in 5 minutes), size (mm) and quality of handwriting were compared. Correlation analysis was performed between SOS outcomes and other fine motor skill measurements and disease characteristics. Intrarater, interrater and test-retest reliability were assessed using the intraclass correlation coefficient (ICC) and Spearman correlation coefficient.ResultsPatients with PD had a smaller (p = 0.043) and slower (p 0.769 for both groups).ConclusionThe SOS-test is a short and effective tool to detect handwriting problems in PD with excellent reliability. It can therefore be recommended as a clinical instrument for standardized screening of handwriting deficits in PD.

背景 帕金森病（Parkinson’s Disease, PD）患者的书写存在特异性异常，但当前尚无针对自发性运动评估的专用工具，使得此类异常在临床实践中难以被准确评估。
研究目的 本研究旨在验证「书写困难系统性筛查量表（Systematic Screening of Handwriting Difficulties，简称SOS测试）」在帕金森病患者中的应用效度。
研究方法 本研究采用SOS测试对87名帕金森病患者及26名年龄匹配的健康对照者的书写表现进行评估。其中67名患者在1个月内接受了二次测试。要求受试者在5分钟内尽可能抄写一段文本，并按照日常书写习惯做到既工整又快速。研究比较了两组的书写速度（5分钟内书写字母数）、字体大小（以毫米为单位）及书写质量。此外，本研究还对SOS测试结果与其他精细运动功能评估指标及疾病特征进行了相关性分析。采用组内相关系数（intraclass correlation coefficient, ICC）与斯皮尔曼相关系数，分别评估了评定者内一致性、评定者间一致性及重测信度。
研究结果 帕金森病患者的字体尺寸更小（p=0.043）、书写速度更慢，两组的相关系数均为0.769。
研究结论 SOS测试是一种简短高效的帕金森病患者书写障碍筛查工具，且具备优异的信度。因此，该测试可作为标准化筛查帕金森病患者书写功能缺损的临床工具加以推广应用。