Intake Questionnaire – Parkinson’s Specific

Abstract

The Intakevragenlijst – Parkinson-specifiek (Intake Questionnaire – Parkinson-specific) is a clinical screening instrument designed for individuals diagnosed with Parkinson’s Disease. Its primary function is to systematically inventory the functional limitations that cause the most significant hindrance or disability to the individual. This tool centers around crucial physiotherapy domains, including the identification of major functional problems, episodes of freezing of gait, frequency of fall incidents, and overall physical activity levels. It is typically administered prior to the initial physiotherapy consultation to facilitate focused assessment and treatment planning.

Keywords

Parkinson’s Disease, Intake Questionnaire, Clinical Assessment, Physiotherapy, Mobility, Freezing of Gait, Fall Incidents, Functional Limitation, KNGF Guideline.

Authors

The currently available version of the Intakevragenlijst is derived from the official KNGF Guideline for Parkinson’s Disease (KNGF-richtlijn Ziekte van Parkinson), published in 2016.

Purpose

The central purpose of the Intakevragenlijst is to serve as an efficient pre-consultation screening mechanism. By providing the questionnaire to the patient a few days before their first appointment, the physiotherapist ensures that the patient has sufficient time to calmly reflect upon and document their most pressing functional issues and limitations related to their Parkinson’s Disease.

This instrument helps streamline the initial consultation process by providing the clinician with a structured overview of patient-reported difficulties, thereby allowing the subsequent objective assessment to be tailored specifically to the patient’s prioritized problems, such as those related to mobility, balance, and the frequency of motor complications like freezing.

Construct

The Intakevragenlijst does not measure a single psychological construct but rather assesses the perceived impact of functional limitations resulting from a neurological disorder on daily life, specifically focusing on domains relevant to physical therapy intervention. The core constructs evaluated include self-reported severity and frequency of specific motor symptoms and resulting disabilities.

• Major Problems: Identification of the chief complaints and areas of greatest functional restriction.
• Freezing of Gait: Assessment of the occurrence and context of temporary, involuntary inability to move (akinesia).
• Fall Incidents: Documentation of the history and frequency of falls, a critical safety concern in Parkinson’s Disease.
• Physical Activity: Evaluation of habitual activity levels and mobility status.

Validity

As a pragmatic clinical intake tool derived from a national professional guideline (KNGF 2016), the explicit, standalone validity metrics (e.g., convergent, discriminant validity) for the Intakevragenlijst itself are typically not published separately. Instead, its validity is established through its alignment with the highly researched and evidence-based domains identified in the KNGF Guideline for Parkinson’s Disease management.

The content validity is high, as the instrument specifically targets established clinical indicators of disease progression and functional decline that are critical for physiotherapy assessment. The domains covered (freezing, falls, activity) are recognized as primary targets for intervention and are validated constructs in the broader literature concerning Parkinsonian motor symptoms.

Reliability

Specific test-retest reliability or internal consistency (e.g., Cronbach’s alpha) data for this specific intake questionnaire are generally integrated within the psychometric evaluation of the larger KNGF Guideline recommendations rather than being reported for the intake form in isolation. Since the questionnaire is designed primarily for initial assessment and problem prioritization, its reliability focuses on the consistency of the patient’s self-report regarding their current major functional limitations.

Factor Analysis

Factor analysis is generally not applicable to instruments designed purely for clinical intake and screening, especially when the instrument is structured to cover distinct, non-overlapping physiotherapy domains (major problems, freezing, falls, physical activity). The instrument functions as a multi-domain checklist and prioritized symptom inventory rather than a scale intended to measure a single latent psychological or physical factor.

Instrument

Test Type: Questionnaire (Self-report/Caregiver-assisted intake form)

Format: Paper-based or digitally fillable questionnaire.

Language Available: Dutch (as derived from the KNGF Guideline).

Population Group: Patients diagnosed with Parkinson’s Disease.

Age Group: Adults and Elderly.

Population Details: Individuals requiring physiotherapy consultation for motor and mobility limitations associated with their condition. Assistance from a caregiver (mantelzorger) is explicitly permitted during completion.

Test Methodology: The list is provided to the patient prior to the first consultation. The patient or caregiver completes the questionnaire by identifying and prioritizing functional limitations across the key domains of mobility, freezing, and fall frequency. The results guide the subsequent clinical examination. The original PDF measurement instrument can be downloaded here: Intakevragenlijst Meetinstrument (Digital Fillable).

Keywords

KNGF, Parkinson’s, Screening Tool, Caregiver Assistance, Mobility/Movement, Activities, Movement System, Fall Risk, Freezing of Gait.

Authors

Author ORCID Identifier: Not specified; authors are associated with the KNGF Guideline development committee (2016).

Affiliation Email addresses: Contact information is typically managed through the official KNGF channels.

Correspondence Address: Correspondence should be directed to the Royal Dutch Society for Physiotherapy (Koninklijk Nederlands Genootschap voor Fysiotherapie – KNGF).

Permissions & Fee and Test Year

The Intakevragenlijst is derived from the 2016 version of the KNGF Guideline for Parkinson’s Disease. It is generally intended for use by physiotherapists adhering to these professional standards in the Netherlands. Usage permissions are implicitly granted for clinical application within the scope of the guideline. Specific commercial licensing fees are typically not applicable for standardized clinical intake forms developed under professional society guidelines, though access may be restricted to KNGF members or subscribers of the full guideline document.

The original PDF explanation form can be downloaded here: Toelichtingsformulier (Explanation Form).

Additional related documentation can be found here: Overig (Other Documentation).

Reference’s

The primary reference for this instrument is the professional guideline from which it originates.

1. KNGF (Koninklijk Nederlands Genootschap voor Fysiotherapie). (2016). KNGF-richtlijn Ziekte van Parkinson [KNGF Guideline Parkinson’s Disease]. Amersfoort, The Netherlands: KNGF.

2. Intakevragenlijst – Parkinson-specifiek. (2016). Measurement instrument derived from the KNGF Guideline.

Items of the Intakevragenlijst – Parkinson-specifiek

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific items comprising the Intakevragenlijst are not detailed in the provided source description. The instrument focuses on four key domains: belangrijke problemen (major problems), freezing (freezing of gait), valincidenten (fall incidents), and fysieke activiteit (physical activity). For the complete list of items and scoring methodology, reference must be made to the official KNGF Guideline (2016) or the linked measurement instrument PDF.