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Wearing Off Questionnaire (WOQ)
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Supplemental - Highly Recommended: Parkinson's Disease (PD)
Recommendations for use: Indicated for studies assessing motor fluctuations.
Short Description of Instrument
"Wearing-off" (WO) is broadly defined as a predictable recurrence of motor and nonmotor symptoms preceding scheduled doses of antiparkinsonian medication. To quantify the change of WO in clinical trials, a 32-item questionnaire (WOQ-32) was initially developed. For practical reasons, this questionnaire was later adapted to a 19-item questionnaire (WOQ-19), also called QUICK, and a 9-item questionnaire (WOQ-9) with the most valuable questions. The Movement Disorder Society has recommended the WOQ-19 and WOQ-9 as tools for screening for WO phenomenon.
Comments/Special Instructions
A number of studies have demonstrated that the WOQ-19 seems to have good accuracy and is an excellent diagnostic tool for both research and clinical practice. WOQ-9 has shown to have excellent sensitivity but poor specificity, and is recommended as a screening tool.
Scoring and Psychometric Properties
Scoring: Both 1-item cutoff and 2-item cutoff were used for WOQ-19 as diagnostic purpose. The questionnaire showed better accuracy when the 2-item cutoff was used, but 1-item cutoff may loss specificity.  
Psychometric Properties: As in WOQ-9, the 1-item or 2-item cutoff has been used and the 2-item cutoff seems to have an improves specificity (from 0.39 to 0.72) and only loses a little sensitivity (from 0.94 to 0.87).
Both the WOQ-19 and WOQ-9 have adequate screening properties for the detection of wearing-off, and have been recommended by MDS as diagnostic screening tools for screening for the presence/absence of wearing-off in PD though the poor specificity needs further clarification. Recent data suggested that the WOQ-19 exhibits reliability and has been validated to use as a diagnostic tool.
Besides relatively poor specificity, the scales cannot be used as rating instruments of the severity of wearing-off.
Key References:
Stacy M, Bowron A, Guttman M, Hauser R, Hughes K, Larsen JP, LeWitt P, Oertel W, Quinn N, Sethi K, Stocchi F. Identification of motor and nonmotor wearing-off in Parkinson's disease: comparison of a patient questionnaire versus a clinician assessment. Mov Disord. 2005 Jun;20(6):726-33.
Stacy M, Hauser R. Development of a Patient Questionnaire to facilitate recognition of motor and non-motor wearing-off in Parkinson's disease. J Neural Transm (Vienna). 2007 Feb;114(2):211-7.
Stacy M, Hauser R, Oertel W, Schapira A, Sethi K, Stocchi F, Tolosa E. End-of-dose wearing off in Parkinson disease: a 9-question survey assessment. Clin Neuropharmacol. 2006 Nov-Dec;29(6):312-21.
Additional References:
Antonini A, Martinez-Martin P, Chaudhuri RK, Merello M, Hauser R, Katzenschlager R, Odin P, Stacy M, Stocchi F, Poewe W, Rascol O, Sampaio C, Schrag A, Stebbins GT, Goetz CG. Wearing-off scales in Parkinson's disease: critique and recommendations. Mov Disord. 2011 Oct;26(12):2169-75.
Mantese CE, Schumacher-Schuh A, Rieder CRM. Clinimetrics of the 9- and 19-Item Wearing-Off Questionnaire: A Systematic Review. Parkinsons Dis. 2018 Apr 1;2018:5308491.
Stacy MA, Murphy JM, Greeley DR, Stewart RM, Murck H, Meng X; COMPASS-I Study Investigators. The sensitivity and specificity of the 9-item Wearing-off Questionnaire. Parkinsonism Relat Disord. 2008;14(3):205-12.
Document last updated August 2022