Northwestern University, Department of Orthopaedic Surgery, 676 N. Saint Clair, Suite 1350, Chicago, IL 60611, USA.
Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL 60064, USA.
Spine J. 2019 Jan;19(1):157-162. doi: 10.1016/j.spinee.2018.05.038. Epub 2018 Aug 23.
BACKGROUND CONTEXT: Despite the prevalence and importance of myelopathy, there is a paucity of objective and quantitative clinical measures. The most commonly used diagnostic tools available are nonquantitative physical exam findings (eg, pathologic reflexes, and gait disturbance) and subjective scoring systems (eg, modified Japanese Orthopaedic Association [mJOA]). A decline in fine motor coordination is a hallmark of early myelopathy, which may be useful for quantitative testing. PURPOSE: To identify if a novel tablet application could provide a quantitative measure of upper extremity dysfunction in cervical spondylotic myelopathy. STUDY DESIGN/SETTING: Prospective cohort study Patient Sample: Adult patients with a diagnosis of cervical spondylotic myelopathy from a board-certified, spine surgeon were compared with age-matched, healthy, and adult control patients. OUTCOME MEASURES: Self-reported function was assessed via the mJOA. Upper extremity function was measured via the fine motor skills (FiMS) tablet test. METHODS: Subjects and controls prospectively completed the mJOA paper survey and the FiMS tablet testing, which consisted of four challenges. RESULTS: After age-matching, 65 controls and 28 myelopathic patients were available for comparison. The mean mJOA was 13.5 ± 2.9 in the myelopathic cohort and 17.3 ± 1.1 in the control cohort (p < .0001). The average scores for challenges 1-4 in control patients were 24.4, 16.3, 3.2, and 6.6, respectively, whereas the average scores for the myelopathic patients were 16.6, 10.5, 1.4, and 1.8, respectively (p values for all four challenges <.001). Based upon the 15 control subjects who repeated FiMS testing four sequential times, intrarater reliability was excellent, yielding an interclass correlation coefficient of 0.88 CONCLUSIONS: The FiMS tablet application produced significantly lower scores in a myelopathic cohort when compared with an age-matched control cohort. This is true for all four challenges in the FiMS tablet application. The test can be completed in 1.5 minutes, producing a reliable, quantitative measure of cervical myelopathy upper extremity function. In summary, the FiMS tablet application is a novel, easily administered, objectively quantifiable test for analyzing cervical spondylotic myelopathy.
背景：尽管脊髓病很常见且很重要，但目前缺乏客观和定量的临床测量方法。现有的最常用的诊断工具是非定量的体格检查结果（例如病理反射和步态障碍）和主观评分系统（例如改良日本骨科协会[mJOA]）。精细运动协调能力下降是早期脊髓病的标志，这可能对定量测试有用。
目的：确定新型平板电脑应用程序是否可以提供颈椎脊髓病上肢功能障碍的定量测量方法。
研究设计/设置：前瞻性队列研究患者样本：与经过认证的脊柱外科医生诊断为颈椎脊髓病的成年患者相比，与年龄匹配的健康成年对照组患者进行比较。
测量结果：通过 mJOA 评估自我报告的功能。通过精细运动技能（FiMS）平板电脑测试测量上肢功能。
方法：受试者和对照组前瞻性地完成了 mJOA 纸质调查和 FiMS 平板电脑测试，该测试由四个挑战组成。
结果：在年龄匹配后，28 例脊髓病患者和 65 例对照组患者可进行比较。脊髓病组的平均 mJOA 为 13.5 ± 2.9，对照组为 17.3 ± 1.1（p <.0001）。对照组患者在四个挑战中的平均得分为 24.4、16.3、3.2 和 6.6，而脊髓病患者的平均得分为 16.6、10.5、1.4 和 1.8（四个挑战的 p 值均 <.001）。基于对重复 FiMS 测试四次的 15 名对照组受试者，组内可靠性极好，产生的组内相关系数为 0.88。
结论：FiMS 平板电脑应用程序在与年龄匹配的对照组相比时，在脊髓病组中产生的分数明显较低。在 FiMS 平板电脑应用程序的所有四个挑战中都是如此。该测试可以在 1.5 分钟内完成，可产生可靠的定量测量颈椎脊髓病上肢功能的方法。总之，FiMS 平板电脑应用程序是一种新颖的、易于管理的、客观可量化的颈椎脊髓病分析测试方法。
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