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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 recovery rates for the JOA and mJOA scores.This figure includes only cases with a recovery rate from -1.0 to +1.0. Only two outliers were omitted (n = 63).
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pone.0123022.g003: Scatterplot of the recovery rates for the JOA and mJOA scores.This figure includes only cases with a recovery rate from -1.0 to +1.0. Only two outliers were omitted (n = 63).

Mentions: In 65 patients (71%) followed at three months postoperatively, the recovery rates were calculated using the Hirabayashi method and compared with each other. The mean JOA recovery rate was 45.1% (range: -33%– 100%, standard deviation: 30.8%), whereas the mean mJOA recovery rate was 38.2% (range: -200%– 100%, standard deviation: 43.0%). A scatterplot of the recovery rates for the JOA and mJOA is shown in Fig 3. In this figure, one outlier whose JOA RR was 0 and mJOA RR was -2.0 (deterioration), was omitted. Their correlations were very strong (rho: 0.75, p <0.001). In two cases, one scale showed recovery while the other showed deterioration. Both of these patients had urinary symptoms. We created a prediction formula to calculate the mJOA RR from the JOA RR using linear regression analysis. The result is as follows:


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 recovery rates for the JOA and mJOA scores.This figure includes only cases with a recovery rate from -1.0 to +1.0. Only two outliers were omitted (n = 63).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0123022.g003: Scatterplot of the recovery rates for the JOA and mJOA scores.This figure includes only cases with a recovery rate from -1.0 to +1.0. Only two outliers were omitted (n = 63).
Mentions: In 65 patients (71%) followed at three months postoperatively, the recovery rates were calculated using the Hirabayashi method and compared with each other. The mean JOA recovery rate was 45.1% (range: -33%– 100%, standard deviation: 30.8%), whereas the mean mJOA recovery rate was 38.2% (range: -200%– 100%, standard deviation: 43.0%). A scatterplot of the recovery rates for the JOA and mJOA is shown in Fig 3. In this figure, one outlier whose JOA RR was 0 and mJOA RR was -2.0 (deterioration), was omitted. Their correlations were very strong (rho: 0.75, p <0.001). In two cases, one scale showed recovery while the other showed deterioration. Both of these patients had urinary symptoms. We created a prediction formula to calculate the mJOA RR from the JOA RR using linear regression analysis. The result is as follows:

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