Unlocking the daily impact of parkinson's challenges through a comprehensive assessment using the ChulaPD ADL questionnaire

Abstract

The ChulaPD ADL questionnaire is a meticulously developed tool by experts in Parkinson's disease (PD) and movement disorders, designed to assess functional limitations in daily activities. It comprehensively evaluates 15 key aspects of daily life through 115 items, including 15 for grading limitations and 100 for ADL limitations. Validated in a pilot study with 30 PD participants, the questionnaire demonstrated strong reliability. In a larger cohort of 231 PD patients, it showed moderate to high correlations with age, Hoehn and Yahr score, levodopa equivalent dose, Montreal Cognitive Assessment, and various UPDRS scores, highlighting its effectiveness in capturing disease-related changes. A grading limitation threshold of 13 points or above was particularly effective in identifying postural instability, achieving 81.4% sensitivity and 50.7% specificity, with an area under the curve (AUC) of 0.747. This underscores its utility in reflecting disease progression and its impact on daily functions. The ChulaPD ADL questionnaire is a relevant, reliable, and valid tool for assessing activities of daily living in patients with PD.

Keywords: Activities in daily living; Functional limitations; Parkinson’s disease; Questionnaire.

Fig. 1

The ROC curve with a cut-off score of 13 points for the sum score of grading limitation identified patients with postural instability with a sensitivity of 81.4%, specificity of 50.7%, and an AUC of 0.747 (p < 0.001; 95% CI for 0.677 – 0.817), suggesting that the sum score of grading limitation was able to distinguish between those patients who are with or without postural instability. Abbreviation: ROC; Receiver Operating Characteristic, AUC; Area Under the Curve, CI; Confidence interval.

Fig. 2

Male participants showed greater impairments in various aspects, including sexual drive, arousal, libido loss, erection/moisture issues, orgasm, and hypersexuality. Males also had more pronounced impairments in intimate relationships, mood, and satisfaction with sexual activities. During motor fluctuations, gender-specific differences were noted, with males experiencing an impact on sexual function, while females did not. Abbreviation: H&Y; Hoehn and Yahr score.

Fig. 3

From the patients’ perspective, impaired mobility and dexterity dysfunction were the most disabling motor symptoms in the earliest stage, while non-motor symptoms like sleep and bowel issues were more pronounced. By H&Y stage 3, mobility became the highest limitation, with a shift from non-motor to motor symptoms. In stages 4 and 5, mobility remained the greatest limitation, with significant sleep and communication issues. Abbreviation: H&Y; Hoehn and Yahr score.