Upper-limb assessment in people with Parkinson disease: Is it a priority for therapists, and which assessment tools are used?

Purpose: To investigate the frequency of physiotherapy and occupational therapy assessment of the upper limb (UL) in people with Parkinson disease (PD) and to identify the impairments and activity limitations assessed and the methods used. Method: A custom-designed questionnaire was used to survey physiotherapists and occupational therapists with previous experience in managing people with PD, using targeted recruitment to invite physiotherapy conference attendees, clinicians employed in movement disorders programmes, and practitioners in neurology and gerontology to respond either on paper or online. Results: Of the 190 respondents (122 physiotherapists, 68 occupational therapists), 54% reported consistently assessing the UL. A majority (>60%) assessed impairments specific to PD, but few quantified these using standardized measures. Activity limitations, largely relating to manual dexterity, were assessed using observational analysis (61%), non-standardized timed activities (46%), and standardized outcome measures (61%), most generic or developed for evaluating other neurological conditions. More than 10% of respondents could not identify an appropriate standardized measure. Conclusions: Slightly more than half of respondents regularly assessed the UL. Respondents reported widespread use of non-standardized methods to assess PD-specific impairments. Standardized measures were more frequently used to evaluate activity limitations, but despite the unique movement disorders associated with PD, the clinimetric properties of most of the tools identified have not been established in this population. Education and further clinimetric investigation of measures in use are needed to facilitate evidence-based practice in this area.