PMID- 26502097
OWN - NLM
STAT- MEDLINE
DCOM- 20160808
LR  - 20220408
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 40
IP  - 21
DP  - 2015 Nov
TI  - The Minimum Clinically Important Difference of the Modified Japanese Orthopaedic 
      Association Scale in Patients with Degenerative Cervical Myelopathy.
PG  - 1653-9
LID - 10.1097/BRS.0000000000001127 [doi]
AB  - STUDY DESIGN: Analysis of the prospective AOSpine CSM-International and North 
      America datasets and survey of AO Spine International. OBJECTIVE: This study aims 
      to define the minimum clinically important difference (MCID) of the modified 
      Japanese Orthopaedic Association (mJOA) in patients with degenerative cervical 
      myelopathy (DCM). SUMMARY OF BACKGROUND DATA: The mJOA is the most frequently 
      used clinician-administered tool to assess functional status in patients with 
      DCM. By defining its MCID, clinicians can better evaluate treatment outcomes for 
      this condition. METHODS: Three methods were used to determine the MCID of the 
      mJOA: (1) distribution-based, (2) anchor-based and receiver operating 
      characteristic (ROC) analysis, and (3) professional opinion. Distribution-based 
      methods were used to estimate the MCID by computing the half standard deviation 
      and standard error of measurement. Using anchor-based methods, mJOA at 12 months 
      after surgery was compared between patients who were "slightly improved" on the 
      Neck Disability Index (NDI) and those who were "unchanged." ROC analysis was 
      performed to compute a discrete integer value for the MCID that yielded the 
      smallest difference between sensitivity and specificity. We repeated anchor-based 
      methods for patients with mild (mJOA: 15-17), moderate (mJOA: 12-14), and severe 
      disease (mJOA <12). RESULTS: The half standard deviation of the baseline mJOA was 
      1.36 and the standard error of measurement was 1.21. The difference in mJOA 
      between patients who "slightly improved" on the NDI and "unchanged" patients was 
      1.11. ROC analysis yielded a value of 2 for the MCID. The survey of 416 spine 
      professionals confirmed these estimates: the mean response was 1.65 +/- 0.66. The 
      MCID significantly varied depending on myelopathy severity: ROC analysis yielded 
      a threshold of 1 for mild, 2 for moderate, and 3 for severe patients. CONCLUSION: 
      The MCID of the mJOA is estimated to be between 1 and 2 points and varies with 
      myelopathy severity. This knowledge will enable clinicians to identify meaningful 
      functional improvements in DCM patients. LEVEL OF EVIDENCE: N/A.
FAU - Tetreault, Lindsay
AU  - Tetreault L
AD  - *Institute of Medical Sciences, University of Toronto, Toronto Western Hospital, 
      University Health Network, Toronto, Ontario, Canada daggerInstitute of Medical 
      Sciences, University of Toronto, Division of Neurosurgery and Spine Program, 
      Toronto Western Hospital, Toronto Western Research Institute, University Health 
      Network, Toronto, Ontario, Canada double daggerUniversity of Washington, Seattle, Washington, 
      USA  section signFaculty of Health Sciences, University of Ontario Institute of Technology 
      (UOIT), UOIT-CMCC Centre for the Study of Disability Prevention and 
      Rehabilitation, Toronto, Ontario, Canada  paragraph signDivision of Neural Repair and 
      Regeneration, Department of Neurosurgery, University of Toronto, The Toronto 
      Western Hospital, University Health Network, Toronto, Ontario, Canada.
FAU - Nouri, Aria
AU  - Nouri A
FAU - Kopjar, Branko
AU  - Kopjar B
FAU - Cote, Pierre
AU  - Cote P
FAU - Fehlings, Michael G
AU  - Fehlings MG
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Aged
MH  - Cervical Cord/physiopathology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - ROC Curve
MH  - Severity of Illness Index
MH  - Spinal Cord Diseases/*classification/*epidemiology/physiopathology
EDAT- 2015/10/27 06:00
MHDA- 2016/08/09 06:00
CRDT- 2015/10/27 06:00
PHST- 2015/10/27 06:00 [entrez]
PHST- 2015/10/27 06:00 [pubmed]
PHST- 2016/08/09 06:00 [medline]
AID - 00007632-201511000-00003 [pii]
AID - 10.1097/BRS.0000000000001127 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2015 Nov;40(21):1653-9. doi: 10.1097/BRS.0000000000001127.