Conventional JOA score for cervical myelopathy has a rater's bias -In comparison with JOACMEQ-

Hosono, Noboru; Takenaka, Shota; Mukai, Yoshihiro; Tateishi, Kosuke; Fujiwara, Yasushi; Morishita, Yuichiro; Konishi, Hiroaki

doi:10.1016/j.jos.2018.02.014

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…However, Fujiwara et al compared the correlation between these two evaluation indices for upper extremity function, and revealed that the JOACMEQ was strongly correlated with upper arm performance (assessed by the Simple Test for evaluating Hand Function [44]), while the JOA scores were not [45]. Moreover, Hosono et al reported that JOA scores have rater's bias, while the JOACMEQ scores do not, because of the nature of self-recording questionnaires [46]. Since the JOA score does not assess patients' satisfaction, disability, general health, or cervical function, the JOACMEQ can more comprehensively and appropriately evaluate the clinical outcomes for cervical myelopathy patients, and its reliability and validity have already been verified [11,12].…”

Section: Discussionmentioning

confidence: 99%

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

et al. 2019

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Study design Retrospective cohort study. Objectives The old-version JOA score for cervical myelopathy (CM) is an evaluation system performed by medical providers that focuses only on neurological function. The purpose of this study was to evaluate patient-reported outcomes using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and to clarify clinical factors that affect the therapeutic effectiveness for CM. Setting Single institute in Japan. Methods We reviewed surgical outcomes for 126 CM patients who were treated by single open-door laminoplasty and were followed at least 2 years. We assessed clinical information, JOACMEQ, JOA scores, and radiographic parameters. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses. Results Laminoplasty resulted in functional improvement in the cervical spine and extremities for 40-50% of the patients, while bladder function showed only minimal recovery. Multivariable analyses revealed that a significant postoperative reduction in neck or shoulder pain influenced the effective functional recovery of the cervical spine. A reduction in arm or hand pain favorably affected the postoperative upper extremity function. Lower age and a postoperative decrease in limb pain were correlated with significantly improved function of the lower extremities. A postoperative reduction in arm pain enhanced the QOL recovery. Conclusions The JOACMEQ makes it possible to analyze multiple aspects of surgical outcomes for patients who undergo cervical spine surgery. Open-door laminoplasty did not provide favorable results for some patients, which highlights the importance of assessing the indications for this procedure and managing postoperative pain.

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Section: Discussionmentioning

confidence: 99%

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

et al. 2019

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“…Secondary outcomes included the JOACMEQ score and the NRS for neck and arm pain. The JOA score consists of six domain scores (upper and lower extremity motor function [4 points], upper and lower extremity sensory function [2 points], trunk sensory function [2 points], and bladder function [3 points]), and is used to evaluate the severity of preoperative and postoperative cervical spondylotic myelopathy [32,33]. The primary outcome was evaluated using the recovery rate described by Hirabayashi et al, as follows: recovery rate (%) = [postoperative JOA score -preoperative JOA score]/[17-pre-operative JOA score] × 100 [5,[34][35][36][37].…”

Section: Clinical Outcome Parametersmentioning

confidence: 99%

“…Patients with JOA recovery rate ≥52.8% were counted. The JOACMEQ score consists of six subscores: upper extremity function, lower extremity function, bladder function, visual analogue scale (VAS ) score of the upper extremity, VAS score of the body trunk, and VAS score of the lower extremity, which primarily evaluates patient-reported outcomes such as quality of life and function of the cervical spine, upper extremities, lower extremities, and bladder [29,33]. We also prospectively collected demographic information (age, BMI, gender), medical history (symptom duration, history of diabetes and hypertension, OPLL), radiological data (C2-7 Cobb angle and K-line status on a neutral lateral view of the cervical spine, MRI T2 high intensity), and the numerical rating scale (NRS) for neck pain and arm pain before surgery and at the nal follow-up (at least 6 months after surgery).…”

Section: Clinical Outcome Parametersmentioning

confidence: 99%

Influence of Preoperative Smoking Status on Clinical Outcomes of Laminoplasty in Patients With Degenerative Cervical Myelopathy: a Prospective Study

Liang

Duan

Chen

et al. 2021

Preprint

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Background: Smoking is considered to be a risk factor for poor clinical outcomes after anterior cervical decompression and fusion surgery. However, it is unclear whether the preoperative smoking status has similar effects on clinical outcomes after laminoplasty. The current research is carried out to determine whether smoking status before laminoplasty affects clinical outcomes in patients with degenerative cervical myelopathy (DCM). Methods: A series of consecutive patients undergoing laminoplasty to treat DCM at a single institution between April 2017 and April 2020 were included. The patients were divided into the following 3 groups: active smoking (AS), passive smoking (PS), and non-smoking (NS). The primary outcome was the recovery rate of JOA at the last follow-up. Secondary outcomes included JOACMEQ score and the NRS (Numerical rating scale) for neck and arm pain. Statistical analysis of among the three groups differences were performed with ANOVA, and multivariable regression analysis was undertaken to explore predictor variables.Result: A total of 158 consecutive patients completed at least 6 months of follow-up. There were 108 men and 50 women. The mean (±standard deviation) age of this series was 57.7 ± 11.6 years. The average recovery rate of JOA, the improvement in the NRS for neck and arm pain, and in each domain of JOACMEQ did not differ significantly among the three groups (P＞0.05). When used 52.8% as the minimal clinically important difference (MCID) of the JOA recovery rate, active smokers (RR=0.950, 95%CI=0.740-1.220) and passive smokers (RR=0.830, 95%CI=0.540-1.277) had similar likelihoods of reaching MCID compared with non-smokers. Logistic regression revealed that age (OR=0.95, 95%CI=0.92-0.98, P=0.001) and preoperative JOA (OR=0.85, 95%CI=0.75-0.95, P=0.004) were risk factors of the recovery rate that did not reach MCID, but smoking status: AS (OR=0.56, 95%CI=0.21-1.47,P=0.24), PS (OR=.087, 95%CI=0.43-1.76, P=0.70), did not affect the clinical outcomes.Conclusion: Over a follow-up period of at least 6 months, active smokers, passive smokers, and non-smokers had similar improvements in clinical outcomes after laminoplasty. Thus, smoking status was not found to be an independent predictor of clinical outcomes after laminoplasty.

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“…However, there is a limitation of JOA score system that JOA score is not determined by patients directly. As one of observer-reported outcomes (OROs), JOA score may be in uenced by subjective bias from the observers (5). In contrast, patient reported outcomes (PROs) are directly from patients about their own body function and treatment feelings, not in uenced by any other person.…”

Section: Introductionmentioning

confidence: 99%

The Patient-reported Japanese Orthopaedic Association Score for Chinese patients with cervical spondylotic myelopathy: an investigation of reliability, validity, and responsiveness

Li,

Pan

et al. 2024

Preprint

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Purpose Japanese Orthopaedic Association (JOA) Score is widely used to measure the neurological functions of patients with cervical spondylotic myelopathy (CSM). However, there is a limitation of JOA score system that JOA score is not determined by patients directly and may be influenced by subjective bias from the observers. This study aims to develop patient-reported JOA score (P-JOA) to address this deficiency. Methods This prospective cohort study involved 120 patients with CSM from November 2021 to December 2022 in our hospital. We developed the Chinese version of P-JOA based on the 17 − 2 points system version JOA score, which is most widely used in Asia. The P-JOA was completed twice by patients (P-JOA 1 and P-JOA 2) preoperatively while JOA score for the patients was evaluated by a physician blinded to the result of P-JOA, and the results of other patient-reported outcomes (OROs) were collected as well, including the MOS item short from healthy survey (SF-36) score, and Neck Disability Index (NDI). The above results were analyzed using the paired t-test, Intraclass Correlation Coefficient (ICC), and weighted κ-test to evaluate the re-test reliability and validity of the P-JOA, as well as its consistency with the JOA. Bland-Altman plot was used method for assessing the measurement error or agreement in this study. Results The mean age of the study population was 54.6 ± 10.1 years. The mean scores of the two P-JOA were 13.4 ± 2.6 and 13.3 ± 2.8, and the difference was not statistically significant (P = 0.595); the ICC of P-JOA 1 and P-JOA 2 was 0.731, and the Cronbach's coefficient was 0.844, and the results suggested that the re-test reliability of the P-JOA was good; The ICC of the P-JOA 2 and the JOA score was 0.932, and the Cronbach's coefficient was 0.965, the results showed that the consistency between the P-JOA and the JOA was excellent. The patients were divided into the severe, moderate, and mild groups according to the JOA score, and there was no statistically significant difference between the P-JOA and the JOA (severe: 7.3 ± 0.5 vs. 6.2 ± 0.6, P = 0.078; moderate: 11.6 ± 0.2 vs. 11.7 ± 0.2, P = 0.551; mild: 15.1 ± 0.1 vs. 14.9 ± 0.2, P = 0.091). The Pearson correlation coefficient between P-JOA and NDI was − 0.104, which is a poor correlation; P-JOA showed a moderate correlation with the physiological function scores in the SF-36, with a Pearson correlation coefficient of 0.464, and correlation with other scores in the SF -36 with poor correlation with other scoring items in the SF-36. Bland-Altman analyses based on difference between the P-JOA 2 and JOA revealed that limits of agreement were − 2.2 to 1.9. Bland-Altman analyses based on ratio between the P-JOA 2 and JOA revealed that limits of agreement were 0.8 to 1.1. Conclusion The P-JOA has good re-test reliability and good agreement with JOA. It has the potential to replace JOA for clinical application to eliminate physicians' subjective bias. However, its clinical validity still needs to be clarified by further prospective follow-up studies.

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Conventional JOA score for cervical myelopathy has a rater's bias -In comparison with JOACMEQ-

Cited by 7 publications

References 13 publications

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Influence of Preoperative Smoking Status on Clinical Outcomes of Laminoplasty in Patients With Degenerative Cervical Myelopathy: a Prospective Study

The Patient-reported Japanese Orthopaedic Association Score for Chinese patients with cervical spondylotic myelopathy: an investigation of reliability, validity, and responsiveness

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