Movement Disorder Society Task Force Report on the Hoehn and Yahr staging scale [HY]: status and recommendations

Christopher G Goetz, Werner Poewe, Olivier Rascol, Cristina Sampaio, Glenn T Stebbins, Carl Edward Counsell, Nir Giladi, Robert G Holloway, Charity G. Moore, Gregor K Wenning, Melvin D Yahr, Lisa Seidl, Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease

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Abstract

The Movement Disorder Society Task Force for Rating Scales for Parkinson's disease (PD) prepared a critique of the Hoehn and Yahr scale (HY). Strengths of the HY scale include its wide utilization and acceptance. Progressively higher stages correlate with neuroimaging studies of dopaminergic loss, and high correlations exist between the HY scale and some standardized scales of motor impairment, disability, and quality of life. Weaknesses include the scale's mixing of impairment and disability and its non-linearity. Because the HY scale is weighted heavily toward postural instability as the primary index of disease severity, it does not capture completely impairments or disability from other motor features of PD and gives no information on nonmotor problems. Direct clinimetric testing of the HY scale has been very limited, but the scale fulfills at least some criteria for reliability and validity, especially for the midranges of the scale (Stages 2-4). Although a "modified HY scale" that includes 0.5 increments has been adopted widely, no clinimetric data are available on this adaptation. The Task Force recommends that: (1) the HY scale be used in its original form for demographic presentation of patient groups; (2) when the HY scale is used for group description, medians and ranges should be reported and analysis of changes should use nonparametric methods; (3) in research settings, the HY scale is useful primarily for defining inclusion/exclusion criteria; (4) to retain simplicity, clinicians should "rate what you see" and therefore incorporate comorbidities when assigning a HY stage; and (5) because of the wide usage of the modified HY scale with 0.5 increments, this adaptation warrants clinimetric testing. Without such testing, however, the original five-point scales should be maintained.
Original languageEnglish
Pages (from-to)1020-1028
Number of pages9
JournalMovement Disorders
Volume19
Issue number9
Early online date16 Jun 2004
DOIs
Publication statusPublished - Sep 2004

Keywords

  • Feasibility Studies
  • Health Status
  • History, 20th Century
  • Movement Disorders
  • Parkinson Disease
  • Questionnaires
  • Reproducibility of Results
  • Hoehn and Yahr scale
  • Parkinson's disease
  • rating scales
  • clinimetrics

Cite this

Goetz, C. G., Poewe, W., Rascol, O., Sampaio, C., Stebbins, G. T., Counsell, C. E., Giladi, N., Holloway, R. G., Moore, C. G., Wenning, G. K., Yahr, M. D., Seidl, L., & Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease (2004). Movement Disorder Society Task Force Report on the Hoehn and Yahr staging scale [HY]: status and recommendations. Movement Disorders, 19(9), 1020-1028. https://doi.org/10.1002/mds.20213