Revanappa Kartik Kumbhar, Moorthy Ranjith K, Jeyaseelan Visalakshi, Rajshekhar Vedantam
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Neurol India. 2015 Jan-Feb;63(1):24-9. doi: 10.4103/0028-3886.152627.
Existing scales for functional grading of patients with cervical spondylotic myelopathy (CSM), such as the Nurick scale and modified Japanese Orthopedic Association (mJOA) scale, do not address certain culture-specific activities of the Indian population while grading patients with CSM.
We modified the Nurick scale and mJOA scale to develop the Indian modifications of Nurick (imNurick) and mJOA scales (imJOA and imJOA scales), respectively, and then evaluated these modified scales in 93 patients with CSM to determine whether these modifications had a meaningful impact on the functional scores of these patients.
There was good interobserver agreement in the assessments documented in all the four scales (Nurick grade, imNurick grade, mJOA scale, and imJOA scale) (kappa = 1). Both Nurick grading (z = 4.4, P = 0.00) and imNurick grading (z = 5.5, P = 0.00) had a valid construct when tested against lower limb mJOA (llmJOA) score. The Indian modified upper limb JOA (imulmJOA) score too had a good construct with modified upper limb JOA (ulmJOA) score (z = 2.5, P = 0.01). There was substantial agreement between Nurick grade and imNurick grade (weighted kappa of 0.75) when taken as a whole group and between ulmJOA score and imulmJOA scores (weighted kappa of 0.75). However, there was significant disagreement between the Nurick grade and imNurick grade scales in patients who were Nurick grade 2 and 3 (kappa = 0.07).
The proposed Indian modifications of Nurick grade and mJOA scale that incorporate the ethnic practices of the Indian population and some Asian population are better discriminators of different levels of functional ability among patients with CSM in this population, as compared to the existing Nurick grading and mJOA scale.
现有的脊髓型颈椎病（CSM）患者功能分级量表，如Nurick量表和改良日本骨科学会（mJOA）量表，在对CSM患者进行分级时未考虑印度人群某些特定文化背景下的活动。
我们分别对Nurick量表和mJOA量表进行修改，制定了印度版Nurick量表（imNurick）和mJOA量表（imJOA），然后在93例CSM患者中对这些修改后的量表进行评估，以确定这些修改是否对这些患者的功能评分有显著影响。
在所有四个量表（Nurick分级、imNurick分级、mJOA量表和imJOA量表）记录的评估中，观察者间一致性良好（kappa = 1）。与下肢mJOA（llmJOA）评分相比，Nurick分级（z = 4.4，P = 0.00）和imNurick分级（z = 5.5，P = 0.00）都具有有效的结构效度。印度改良上肢JOA（imulmJOA）评分与改良上肢JOA（ulmJOA）评分也具有良好的结构效度（z = 2.5，P = 0.01）。将整个组作为一个整体时，Nurick分级和imNurick分级之间有实质性一致性（加权kappa为0.75），ulmJOA评分和imulmJOA评分之间也有实质性一致性（加权kappa为0.75）。然而，在Nurick分级为2级和3级的患者中，Nurick分级量表和imNurick分级量表之间存在显著差异（kappa = 0.07）。
与现有的Nurick分级和mJOA量表相比，所提出的纳入印度人群和一些亚洲人群种族习惯的印度版Nurick分级和mJOA量表，能更好地区分该人群中CSM患者不同水平的功能能力。
