Limits...
Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study.

Kato S, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K, Kawamura N, Masuda K, Kunogi J, Okazaki R, Azuma S, Hara N, Tanaka S, Takeshita K - PLoS ONE (2015)

Bottom Line: The preoperative JOA score and mJOA score were compared to each other and the PRO values.Previous studies using the JOA can be interpreted based on the mJOA; however it is not ideal to use them interchangeably.The validity of both scores was demonstrated by comparing these values to the PRO values.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.

ABSTRACT

Objectives: The Japanese Orthopaedic Association (JOA) score is widely used to assess the severity of clinical symptoms in patients with cervical compressive myelopathy, particularly in East Asian countries. In contrast, modified versions of the JOA score are currently accepted as the standard tool for assessment in Western countries. The objective of the present study is to compare these scales and clarify their differences and interchangeability and verify their validity by comparing them to other outcome measures.

Materials and methods: Five institutions participated in this prospective multicenter observational study. The JOA and modified JOA (mJOA) proposed by Benzel were recorded preoperatively and at three months postoperatively in patients with cervical compressive myelopathy who underwent decompression surgery. Patient reported outcome (PRO) measures, including Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), the Short Form-12 (SF-12) and the Neck Disability Index (NDI), were also recorded. The preoperative JOA score and mJOA score were compared to each other and the PRO values. A Bland-Altman analysis was performed to investigate their limits of agreement.

Results: A total of ninety-two patients were included. The correlation coefficient (Spearman's rho) between the JOA and mJOA was 0.87. In contrast, the correlations between JOA/mJOA and the other PRO values were moderate (/rho/ = 0.03 - 0.51). The correlation coefficient of the recovery rate between the JOA and mJOA was 0.75. The Bland-Altman analyses showed that limits of agreement were 3.6 to -1.2 for the total score, and 55.1% to -68.8% for the recovery rates.

Conclusions: In the present study, the JOA score and the mJOA score showed good correlation with each other in terms of their total scores and recovery rates. Previous studies using the JOA can be interpreted based on the mJOA; however it is not ideal to use them interchangeably. The validity of both scores was demonstrated by comparing these values to the PRO values.

No MeSH data available.


Related in: MedlinePlus

Scatterplot of the total scores for the JOA and mJOA scores (n = 92).
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pone.0123022.g001: Scatterplot of the total scores for the JOA and mJOA scores (n = 92).

Mentions: The mean preoperative JOA score was 11.2 (range: 3.0–16.5, standard deviation: 2.5), whereas the mean mJOA score was 12.4 (range: 5–17, standard deviation: 2.5). A scatterplot of the JOA and mJOA scores is shown in Fig 1, and the correlations between the preoperative scores are summarized in Table 2. The JOA and mJOA scores were very strongly correlated with each other (rho = 0.87, p <0.001). The median of the JOA motor function scores was 5. The correlation was found to be weaker in those with a motor function score less than 5 (n = 37, rho = 0.64) than in those with milder motor dysfunction (n = 55, rho = 0.77). On the other hand, the correlations between the JOA/mJOA scores and the other PRO values were not as strong. JOACMEQ QOL score, SF-12 PCS and NDI showed moderate correlations (/rho/: 0.41–0.51), whereas SF-12 MCS did not (/rho/: 0.03–0.05). While the very strong correlation between the JOA and mJOA scores demonstrates convergent validity, the moderate correlation with other PRO values suggests divergent validity. We created a prediction formula to calculate the total scores for the mJOA from the score of the JOA using linear regression analysis. The result is as follows:mJOA total = 2.39+0.89×(JOA total)The R2 of this equation was 0.78.


Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study.

Kato S, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K, Kawamura N, Masuda K, Kunogi J, Okazaki R, Azuma S, Hara N, Tanaka S, Takeshita K - PLoS ONE (2015)

Scatterplot of the total scores for the JOA and mJOA scores (n = 92).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383381&req=5

pone.0123022.g001: Scatterplot of the total scores for the JOA and mJOA scores (n = 92).
Mentions: The mean preoperative JOA score was 11.2 (range: 3.0–16.5, standard deviation: 2.5), whereas the mean mJOA score was 12.4 (range: 5–17, standard deviation: 2.5). A scatterplot of the JOA and mJOA scores is shown in Fig 1, and the correlations between the preoperative scores are summarized in Table 2. The JOA and mJOA scores were very strongly correlated with each other (rho = 0.87, p <0.001). The median of the JOA motor function scores was 5. The correlation was found to be weaker in those with a motor function score less than 5 (n = 37, rho = 0.64) than in those with milder motor dysfunction (n = 55, rho = 0.77). On the other hand, the correlations between the JOA/mJOA scores and the other PRO values were not as strong. JOACMEQ QOL score, SF-12 PCS and NDI showed moderate correlations (/rho/: 0.41–0.51), whereas SF-12 MCS did not (/rho/: 0.03–0.05). While the very strong correlation between the JOA and mJOA scores demonstrates convergent validity, the moderate correlation with other PRO values suggests divergent validity. We created a prediction formula to calculate the total scores for the mJOA from the score of the JOA using linear regression analysis. The result is as follows:mJOA total = 2.39+0.89×(JOA total)The R2 of this equation was 0.78.

Bottom Line: The preoperative JOA score and mJOA score were compared to each other and the PRO values.Previous studies using the JOA can be interpreted based on the mJOA; however it is not ideal to use them interchangeably.The validity of both scores was demonstrated by comparing these values to the PRO values.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.

ABSTRACT

Objectives: The Japanese Orthopaedic Association (JOA) score is widely used to assess the severity of clinical symptoms in patients with cervical compressive myelopathy, particularly in East Asian countries. In contrast, modified versions of the JOA score are currently accepted as the standard tool for assessment in Western countries. The objective of the present study is to compare these scales and clarify their differences and interchangeability and verify their validity by comparing them to other outcome measures.

Materials and methods: Five institutions participated in this prospective multicenter observational study. The JOA and modified JOA (mJOA) proposed by Benzel were recorded preoperatively and at three months postoperatively in patients with cervical compressive myelopathy who underwent decompression surgery. Patient reported outcome (PRO) measures, including Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), the Short Form-12 (SF-12) and the Neck Disability Index (NDI), were also recorded. The preoperative JOA score and mJOA score were compared to each other and the PRO values. A Bland-Altman analysis was performed to investigate their limits of agreement.

Results: A total of ninety-two patients were included. The correlation coefficient (Spearman's rho) between the JOA and mJOA was 0.87. In contrast, the correlations between JOA/mJOA and the other PRO values were moderate (/rho/ = 0.03 - 0.51). The correlation coefficient of the recovery rate between the JOA and mJOA was 0.75. The Bland-Altman analyses showed that limits of agreement were 3.6 to -1.2 for the total score, and 55.1% to -68.8% for the recovery rates.

Conclusions: In the present study, the JOA score and the mJOA score showed good correlation with each other in terms of their total scores and recovery rates. Previous studies using the JOA can be interpreted based on the mJOA; however it is not ideal to use them interchangeably. The validity of both scores was demonstrated by comparing these values to the PRO values.

No MeSH data available.


Related in: MedlinePlus