STUDY DESIGN: Prospective cross-sectional blinded-assessor cohort study. OBJECTIVE: To determine the inter-rater reliability of the modified Japanese Orthopaedic Association (mJOA) in a large cohort of degenerative cervical myelopathy (DCM) patients. SUMMARY OF BACKGROUND DATA: The mJOA score is widely accepted as the primary outcome measure in DCM; it has been utilized in clinical practice guidelines and directly influences treatment recommendations, but its reliability has not been established. METHODS: A refined version of the mJOA was administered to DCM patients by 2 or more blinded clinicians. Inter-rater reliability was measured using intra-class correlation (ICC), agreement, and mean difference for mJOA total score and subscores. Data were also analyzed with ANOVA for differences by mJOA severity (mild: 15-17, moderate: 12-14, severe: < 12), assessor, assessment order, previous surgery, age, and sex. RESULTS: 154 DCM patients underwent 322 mJOA assessments (183 paired assessments). ICC was 0.88 for total mJOA, 0.79 for upper extremity (UE) motor, 0.84 for lower extremity (LE) motor, 0.63 for UE sensation, and 0.78 for urinary function subscores. Paired assessments were identical across all 4 subscores in 25%. The mean difference in mJOA was 0.93 points between assessors, and this differed by severity (mild: 0.68, moderate: 1.24, severe: 0.87, p = 0.001). Differences of > = 2 points occurred in 19%. Disagreement between mild and moderate severity occurred in 12% of patients. Other variables did not demonstrate significant relationships with mJOA scores. CONCLUSION: The inter-rater reliability of total mJOA and its subscores is good, except for UE sensory function (moderate). However, the vast majority of assessments differed between observers, indicating that this measure should be interpreted carefully, particularly when near the threshold between severity categories, or when a patient is reassessed for deterioration. Further efforts to educate clinicians on administration and refine UE sensory subscore may enhance the reliability of this tool.Level of Evidence: 1.
STUDY DESIGN: Prospective cross-sectional blinded-assessor cohort study. OBJECTIVE: To determine the inter-rater reliability of the modified Japanese Orthopaedic Association (mJOA) in a large cohort of degenerative cervical myelopathy (DCM) patients. SUMMARY OF BACKGROUND DATA: The mJOA score is widely accepted as the primary outcome measure in DCM; it has been utilized in clinical practice guidelines and directly influences treatment recommendations, but its reliability has not been established. METHODS: A refined version of the mJOA was administered to DCMpatients by 2 or more blinded clinicians. Inter-rater reliability was measured using intra-class correlation (ICC), agreement, and mean difference for mJOA total score and subscores. Data were also analyzed with ANOVA for differences by mJOA severity (mild: 15-17, moderate: 12-14, severe: < 12), assessor, assessment order, previous surgery, age, and sex. RESULTS: 154 DCMpatients underwent 322 mJOA assessments (183 paired assessments). ICC was 0.88 for total mJOA, 0.79 for upper extremity (UE) motor, 0.84 for lower extremity (LE) motor, 0.63 for UE sensation, and 0.78 for urinary function subscores. Paired assessments were identical across all 4 subscores in 25%. The mean difference in mJOA was 0.93 points between assessors, and this differed by severity (mild: 0.68, moderate: 1.24, severe: 0.87, p = 0.001). Differences of > = 2 points occurred in 19%. Disagreement between mild and moderate severity occurred in 12% of patients. Other variables did not demonstrate significant relationships with mJOA scores. CONCLUSION: The inter-rater reliability of total mJOA and its subscores is good, except for UE sensory function (moderate). However, the vast majority of assessments differed between observers, indicating that this measure should be interpreted carefully, particularly when near the threshold between severity categories, or when a patient is reassessed for deterioration. Further efforts to educate clinicians on administration and refine UE sensory subscore may enhance the reliability of this tool.Level of Evidence: 1.
Authors: Aria Nouri; Enrico Tessitore; Granit Molliqaj; Torstein Meling; Karl Schaller; Hiroaki Nakashima; Yasutsugu Yukawa; Josef Bednarik; Allan R Martin; Peter Vajkoczy; Joseph S Cheng; Brian K Kwon; Shekar N Kurpad; Michael G Fehlings; James S Harrop; Bizhan Aarabi; Vafa Rahimi-Movaghar; James D Guest; Benjamin M Davies; Mark R N Kotter; Jefferson R Wilson Journal: Global Spine J Date: 2022-02
Authors: Benjamin M Davies; Oliver Mowforth; Helen Wood; Zahabiya Karimi; Iwan Sadler; Lindsay Tetreault; Jamie Milligan; Jamie R F Wilson; Sukhvinder Kalsi-Ryan; Julio C Furlan; Yoshiharu Kawaguchi; Manabu Ito; Carl Moritz Zipser; Timothy F Boerger; Alexander R Vaccaro; Rory K J Murphy; Mike Hutton; Ricardo Rodrigues-Pinto; Paul A Koljonen; James S Harrop; Bizhan Aarabi; Vafa Rahimi-Movaghar; Shekar N Kurpad; James D Guest; Jefferson R Wilson; Brian K Kwon; Mark R N Kotter; Michael G Fehlings Journal: Global Spine J Date: 2022-02
Authors: Khadija H Soufi; Tess M Perez; Alexis O Umoye; Jamie Yang; Maria Burgos; Allan R Martin Journal: J Clin Med Date: 2022-03-05 Impact factor: 4.241
Authors: Lindsay Tetreault; Philip Garwood; Aref-Ali Gharooni; Alvaro Yanez Touzet; Laura Nanna-Lohkamp; Allan Martin; Jefferson Wilson; James S Harrop; James Guest; Brian K Kwon; James Milligan; Alberto Martinez Arizala; K Daniel Riew; Michael G Fehlings; Mark R N Kotter; Sukhvinder Kalsi-Ryan; Benjamin M Davies Journal: Global Spine J Date: 2021-12-31