The Minimum Clinically Important Difference of the modified Japanese Orthopaedic Association Scale in Patients with Degenerative Cervical Myelopathy
Notice bibliographique
Résumé
Introduction The modified Japanese Orthopaedic Association (mJOA) score is the most frequently used clinician-administered tool to assess functional status in patients with degenerative cervical myelopathy (DCM). By defining the minimum clinically important difference (MCID) for this scale, clinicians can evaluate treatment outcomes for this condition and better interpret evidence from clinical studies. This study aims to establish the MCID of the mJOA in patients with CSM. Material and Methods Three different 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. The first two methods were accomplished using data from 517 patients enrolled in the AOSpine CSM-North America or CSM-International studies. 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 “slightly improved” on the Neck Disability Index (NDI) and those who were “unchanged.” ROC analysis was then performed to compute a discrete integer value for the MCID that yielded the smallest difference between sensitivity and specificity. Finally, MCID estimates were obtained by surveying members of AOSpine International. We repeated the anchor-based methods for patients with mild (mJOA: 15–17), moderate (mJOA: 12–14) and severe disease (mJOA < 12). Results Our cohort consisted of 315 men and 202 women, with ages ranging from 21 to 86 years (mean age: 56.37 ± 11.60). The mean baseline mJOA score was 12.48 ± 2.71. One hundred and twenty-nine patients were classified as mild (mJOA = 15–17) preoperatively, 208 as moderate (mJOA = 12–14) and 180 as severe (mJOA < 12). Based on the NDI at 12-months following surgery, 76 (14.70%) patients worsened (NDI < −7.5), 130 (25.15%) were unchanged (−7.5≤NDI < 7.5), 87 (16.83%) slightly improved (7.5≤NDI < 15) and 224 (43.33) showed marked improvements (15≤NDI). 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 those who were “unchanged” was 1.11. ROC analysis yielded a value of 2 for the MCID (Fig. 1). The survey of 416 spine professionals confirmed these estimates: The mean response was 1.65 ± 0.66, although the most commonly selected answer was 2 (39.42%). The MCID significantly varied depending on myelopathy severity: ROC analysis yielded a threshold of 1 for mild patients, 2 for moderate patients and 3 for severe patient. Conclusion The MCID of the mJOA is estimated to be between 1 and 2 points and varies significantly with myelopathy severity. This knowledge will enable clinicians to identify meaningful functional improvements in surgically treated CSM patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».