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

A Bland–Altman plot comparing the JOA and mJOA scores.The bias is shown as a solid line, and the upper and lower limits of agreement are shown as broken lines.
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pone.0123022.g002: A Bland–Altman plot comparing the JOA and mJOA scores.The bias is shown as a solid line, and the upper and lower limits of agreement are shown as broken lines.

Mentions: A Bland–Altman plot showing the differences between the two scores (mJOA−JOA) plotted against the mean of the two scores is shown in Fig 2. The mean difference between the two scores (the bias) was 1.2 (95% confidence interval: 0.9–1.5, standard deviation: 1.21). The upper and lower limits of agreement were 3.6 and -1.2, respectively. This range was well above the threshold we set based on an assumed MCID [21]; from this result, we were able to conclude that it is not ideal to interchange the JOA and mJOA.


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)

A Bland–Altman plot comparing the JOA and mJOA scores.The bias is shown as a solid line, and the upper and lower limits of agreement are shown as broken lines.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0123022.g002: A Bland–Altman plot comparing the JOA and mJOA scores.The bias is shown as a solid line, and the upper and lower limits of agreement are shown as broken lines.
Mentions: A Bland–Altman plot showing the differences between the two scores (mJOA−JOA) plotted against the mean of the two scores is shown in Fig 2. The mean difference between the two scores (the bias) was 1.2 (95% confidence interval: 0.9–1.5, standard deviation: 1.21). The upper and lower limits of agreement were 3.6 and -1.2, respectively. This range was well above the threshold we set based on an assumed MCID [21]; from this result, we were able to conclude that it is not ideal to interchange the JOA and mJOA.

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