Clinical Autonomic Research

, Volume 29, Issue 1, pp 105–112 | Cite as

Initial validation of symptom scores derived from the orthostatic discriminant and severity scale

  • Jacquie Baker
  • Justin R. Paturel
  • David M. Sletten
  • Phillip A. Low
  • Kurt KimpinskiEmail author
Research Article



To develop a scale to quantify and discriminate orthostatic from non-orthostatic symptoms. In the current study, we present validation and reliability of orthostatic and non-orthostatic symptom scores taken from the orthostatic discriminate and severity scale (ODSS).


Validity and reliability were assessed in participants with and without orthostatic intolerance. Convergent validity was assessed by correlating symptoms scores with previously validated tools [autonomic symptom profile (ASP) and the orthostatic hypotension questionnaire (OHQ)]. Clinical validity was assessed by correlating scores against standardized autonomic testing. Test–retest reliability was calculated using an intra-class correlation coefficient.


Convergent validity: orthostatic (OS) and non-orthostatic (NS) symptom scores from 77 controls and 67 patients with orthostatic intolerance were highly correlated with both the orthostatic intolerance index of the ASP (OS: r = 0.903; NS: r = 0.651; p < 0.001) and the composite score of the OHQ: (OS: r = 0.800; NS: r = 0.574; p < 0.001). Clinical validity: symptom scores were significantly correlated with the total composite autonomic severity score (OS: r = 0.458; NS: r = 0.315; p < 0.001), and the systolic blood pressure change during head-up tilt (OS: r = − 0.445; NS: r = − 0.354; p < 0.001). In addition, patients with orthostatic intolerance had significantly higher symptom scores compared to controls (OS: 66.5 ± 18.1 vs. 17.4 ± 12.9; NS: 19.9 ± 11.3 vs. 10.2 ± 6.8; p < 0.001, respectively). Test–retest reliability: Both orthostatic and non-orthostatic symptom scores were highly reliable (OS: r = 0.956 and NS: r = 0.574, respectively; p < 0.001) with an internal consistency of 0.978 and 0.729, respectively.


Our initial results demonstrate that the ODSS is capable of producing valid and reliable orthostatic and non-orthostatic symptom scores. Further studies are ongoing to test sensitivity, specificity and symptom severity.


Orthostatic intolerance Autonomic dysfunction Autonomic reflex screen Questionnaires 


Author contributions

JB and KK each contributed to experimental design, data analysis and manuscript preparation.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, there are no conflicts of interest.

Supplementary material

10286_2018_511_MOESM1_ESM.pdf (328 kb)
Supplementary material 1 (PDF 327 kb)


  1. 1.
    Low P, Sandroni P, Joyner MJ, Shen W (2008) Postural tachycardia syndrome. In: Low PA, Benarroch EE (eds) Clinical autonomic disorders, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, pp 515–533Google Scholar
  2. 2.
    Lanier JB, Mote MB, Clay EC (2011) Evaluation and management of orthostatic hypotension. Am Fam Physicians 84:527–536Google Scholar
  3. 3.
    Low P, Benarroch E (2008) Clinical autonomic disorders. Third. Wolters Kluwer Health/Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  4. 4.
    Kimpinski K, Iodice V, Sandroni P, Low PA (2010) Postural tachycardia syndrome and pregnancy effect of pregnancy on postural tachycardia syndrome. Mayo Clin Proc 85:639–644CrossRefGoogle Scholar
  5. 5.
    Freeman R, Wieling W, Axelrod FB et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21:69–72CrossRefGoogle Scholar
  6. 6.
    Bleasdale-Barr KM, Mathias CJ (1998) Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension. J R Soc Med 91:355–359CrossRefGoogle Scholar
  7. 7.
    Suarez G, Opfer-Gehrking TL, Offord K et al (1999) The autonomic symptom profile: a new instrument to assess autonomic symptoms. Neurology 52:523–528CrossRefGoogle Scholar
  8. 8.
    Kaufmann H, Malamut R, Norcliffe-Kaufmann L et al (2012) The Orthostatic hypotension questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res 22:79–90CrossRefGoogle Scholar
  9. 9.
    Low P, Opfer-Gehrking TL (1999) The autonomic laboratory. Am J Electroneurodiagnostic Technol 39:65–76CrossRefGoogle Scholar
  10. 10.
    Low PA (2003) Testing the autonomic nervous system. Semin Neurol 23:407–421CrossRefGoogle Scholar
  11. 11.
    Low P (1993) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 68:748–752CrossRefGoogle Scholar
  12. 12.
    Kimpinski K, Figueroa JJ, Singer W et al (2012) A prospective, 1-year follow-up study of postural tachycardia syndrome. Mayo Clin Proc 87:746–752CrossRefGoogle Scholar
  13. 13.
    Sheldon RS, Grubb BP II, Olshansky B et al (2015) 2015 Heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope hhs public access. Hear Rhythm 12:41–63CrossRefGoogle Scholar
  14. 14.
    Moya A, Sutton R (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30:2631–2671CrossRefGoogle Scholar
  15. 15.
    Mathias CJ, Mallipeddi R, Bleasdale-Barr K (1999) Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 246:893–898CrossRefGoogle Scholar
  16. 16.
    Shannon JR, Jordan J, Diedrich A et al (2000) Sympathetically mediated hypertension in autonomic failure. Circulation 101:2710–2715CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jacquie Baker
    • 1
    • 3
  • Justin R. Paturel
    • 1
  • David M. Sletten
    • 4
  • Phillip A. Low
    • 4
  • Kurt Kimpinski
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Clinical Neurological Sciences, London Health Sciences CentreRm. C7-131, University HospitalLondonCanada
  2. 2.Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  3. 3.School of KinesiologyWestern UniversityLondonCanada
  4. 4.Department of NeurologyMayo ClinicRochesterUSA

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