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Unified Dyskinesia Rating Scale (UDysRS)
Please visit this website for more information about the instrument: Unified Dyskinesia Rating Scale
The instrument is freely available for Individual/Personal use. Permission is required to use this instrument for any other purpose than individual use. This includes clinical trials and training programs. For all other uses please consult the permission form located on the first page of the Scale.
Supplemental - Highly Recommended: Parkinson's Disease [Recommended as Core for Dyskinesia studies]
Recommendations for use: Indicated for studies assessing dyskinesia.
Short Description of Instrument
The Unified Dyskinesia Rating Scale (UDysRS) was developed and clinimetrically tested prior to its 2018 presentation. The UDysRS has four parts: I) Historical Disability (patient perceptions) of On-Dyskinesia impact (maximum 44 points); II) Historical Disability (patient perceptions) of Off-Dystonia impact (maximum 16 points); III) Objective Impairment (Dyskinesia severity, anatomical distribution over seven body regions, and type (choreic or dystonic) based on four activities observed or video-recorded (28 points); IV) Objective Disability based on Part III activities (maximum 16 points).
Part I has two components: Part 1A is a clinician rated outcome with one question assessing the portion of the day the subject has dyskinesia.  Part 1B has 10 questions in a patient reported outcomes (or patient and caregiver completed outcomes) format assessing the functional impact of dyskinesia on daily functions. This section is based on the Lang-Fahn Scale, but with significant modification.
Part II has two components: Part 2A is clinician rated outcome with one question to determine the hours per day with Off-dystonia. Part 2B is a patient reported outcome (or patient and caregiver reported outcome) with 3 questions assessing the functional impact of off-dystonia. This section is based on the MDS-UPDRS.
Part III is a clinician rated outcome assessing the objective impairment of dyskinesia severity and anatomical distribution based on four activities observed or video recorded. Seven anatomical areas are rated for severity of dyskinesia or dystonia on each task with the highest score for the four tasks recorded as the final score for each body region. This section is based on the Abnormal Involuntary Movement Scale (AIMS).
Part IV is a clinician rated outcome that integrates the data from Part III with the rater's clinical observations and judgments to assess objective disability (4 items with ratings based on the same four activities in Part III). This section is based on the RDRS.
The scale has gained wide acceptance internationally and has been translated in over 15 non-English officially tested and clinimetrically validated language versions.
Scoring and Psychometric Properties
Scoring: Each of the four parts are summed to provide a total UDysRS score.  Each item is based on a 5-point Likert metric (0 to 4) with scores ranging from 0-44 for Part I, 0-16 for Part II, 0-28 for Part III, and 0-16 for Part IV, with a total score range of 0-104.
Psychometric Properties: The UDysRS items were tested clinimetrically within the context of scale validation of each part rather than testing each item. The UDysRS is a clinimetrically sound rating scale for dyskinesia in PD, demonstrating acceptable levels of internal consistency, inter- and intra-rater reliability, and construct validity. Differential item functioning (DIF) analysis was performed on a sample of more than 3,000 ratings. Most items showed no gender, age or race/ethnicity DIF, and when DIF was identified, the magnitude statistic was always in the 'Negligible" range with designated "minimal scale level impact."
Key Reference:
Goetz CG, Nutt JG, Stebbins GT. The Unified Dyskinesia Rating Scale: presentation and clinimetric profile. Mov Disord. 2008 Dec 15;23(16):2398-403.
Additional References:
Goetz CG, Stebbins GT, Wang L, LaPelle NR, Luo S, Tilley BC. IPMDS-Sponsored Scale Translation Program: Process, Format, and Clinimetric Testing Plan for the MDS-UPDRS and UDysRS. Mov Disord Clin Pract. 2014 Jun;1(2):97-101.
Luo S, Liu Y, Teresi JA, Stebbins GT, Goetz CG. Differential item functioning in the Unified Dyskinesia Rating Scale (UDysRS). Mov Disord. 2017 Aug;32(8):1244-1249.
Luo S, Ren X, Han W, Goetz CG, Stebbins GT. Missing Data in the Unified Dysksinesia Rating Scale (UDysRS). Mov Disord Clin Pract. 2018 Aug 24;5(5):523-526.
Ren X, Lin J, Luo S, Goetz CG, Stebbins GT, Cubo E. Differential Item Functioning in the Unified Dyskinesia Rating Scale (UDysRS) based on Duration of Parkinson's Disease and Dyskinesia. Mov Disord. 2019;34:S492.
Document last updated August 2022