Choy Wen Jie, Chen Lingxiao, Quel De Oliveira Camila, Verhagen Arianne P, Damodaran Omprakash, Anderson David B
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
Department of Neurosurgery, Nepean Hospital, Sydney, Australia.
J Spine Surg. 2022 Mar;8(1):149-162. doi: 10.21037/jss-21-109.
Degenerative cervical myelopathy (DCM) is a common progressive neurological disorder which may affect one's activities of daily living or even result in paraplegia/tetraplegia if left untreated. Currently, there is lack of consensus of the gait assessment tools for DCM. This systematic review aims to (I) provide an appraisal of the psychometric properties of the available gait assessment tools for DCM, (II) to assess their methodological quality according to The Consensus-based Standards for the selection of health Measurement COSMIN risk of bias checklist and (III) to assess each measurement property result against externally validated criteria.
Six electronic full-text databases [PubMed (via NLM database], Medline (via OvidSP), CINAHL (via Ebsco), EMBASE (via Ovid), PsycINFO (via CSA) and Web of Science (via Thomson Reuters)] were systematically searched from inception to June 2020. The methodological quality of each study was analysed using the COSMIN risk of bias checklist. The measurement property result and methodological quality of each study were evaluated.
Twenty studies were included from 3,339 citations retrieved. Twelve assessment tools for assessing gait in DCM were identified. According to COSMIN criteria, only five studies (25%) included in this review were found to have "very good" methodological quality. For construct validity, five tools had "sufficient" quality. For reliability, two assessment tools [the Total modified Japanese Orthopaedic Association Score (Italian Translation) (mJOA-ITTotal) and the modified Japanese Orthopaedic Association (Italian Translation) Motor dysfunction of the Lower Extremity (mJOA-ITMDLE)] were rated as "sufficient" for interobserver reliability while six assessment tools (the 10 second step test (10 sec ST), 30 minute walk test (30MWT), foot tapping test, mJOA-ITTotal, mJOA-ITMDLE and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire) were rated as "sufficient" for test-retest reliability. The JOA (6 scores) received a "sufficient" rating for internal consistency. No assessment was available for responsiveness, as only the effect size was available.
Based upon current evidence, the mJOA in combination with an objective functional test (i.e., 30MWT) is recommended for clinicians assessing gait in DCM, although this may change with an increase in the number of studies completed. Given the importance of assessment tools possessing adequate measurement properties, a focus on studies in this area is warranted.
退行性颈椎病脊髓病（DCM）是一种常见的进行性神经疾病，如果不治疗，可能会影响患者的日常生活活动，甚至导致截瘫/四肢瘫痪。目前，对于DCM的步态评估工具尚未达成共识。本系统评价旨在：（I）对现有的DCM步态评估工具的心理测量特性进行评估；（II）根据基于共识的健康测量选择标准（COSMIN）偏倚风险清单评估其方法学质量；（III）根据外部验证标准评估每个测量特性结果。
对六个电子全文数据库[PubMed（通过NLM数据库）、Medline（通过OvidSP）、CINAHL（通过Ebsco）、EMBASE（通过Ovid）、PsycINFO（通过CSA）和Web of Science（通过汤森路透）]从建库至2020年6月进行系统检索。使用COSMIN偏倚风险清单分析每项研究的方法学质量。对每项研究的测量特性结果和方法学质量进行评估。
从检索到的3339篇文献中纳入了20项研究。确定了12种用于评估DCM步态的评估工具。根据COSMIN标准，本评价纳入的研究中只有五项（25%）具有“非常好”的方法学质量。对于结构效度，有五种工具质量“足够”。对于信度，两种评估工具[日本矫形外科学会总评分（意大利语翻译）（mJOA-ITTotal）和日本矫形外科学会（意大利语翻译）下肢运动功能障碍（mJOA-ITMDLE）]在观察者间信度方面被评为“足够”，而六种评估工具（10秒步速测试（10 sec ST）、30分钟步行测试（30MWT）、足部轻拍测试、mJOA-ITTotal、mJOA-ITMDLE和日本矫形外科学会颈椎病评估问卷）在重测信度方面被评为“足够”。JOA（6分制）在内一致性方面获得“足够”评级。由于仅提供了效应量，因此未对反应度进行评估。
根据目前的证据，建议临床医生在评估DCM步态时使用mJOA并结合客观功能测试（即30MWT），尽管随着完成研究数量的增加，这一建议可能会改变。鉴于评估工具具有足够测量特性的重要性，有必要关注该领域的研究。
