Chang Shuai, Xu Nanfang, Luo Yubo, Wang Shaobo, Liu Zhongjun
Department of Orthopedics, Peking University Third Hospital, Beijing, 100191 China.
Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, 100191 China.
J Clin Transl Res. 2022 Nov 15;8(6):594-601. eCollection 2022 Dec 29.
BACKGROUND AND AIM: The modified Japanese Orthopaedic Association (mJOA) scale is one of the primary measures of neurological function used on patients with degenerative cervical myelopathy (DCM). Contrary to some reports, the mJOA is not based on patient-reported outcomes as it is an assessment conducted by physicians, allied health professionals, or trained staff. To date, the accuracy of post-operative recall by DCM patients of their pre-operative neurological function, as assessed by the mJOA scale, has not been examined. This study, therefore, aimed to evaluate recall accuracy in DCM patients using the mJOA scale. METHODS: This study analyzed recall capacity of DCM patients who had undergone anterior cervical discectomy and fusion by a single surgeon at a large academic spine center between February 2012 and August 2017. Patient recall of neurological function pre-surgery was assessed at 3, 12, and 24 months post-surgery using the mJOA scale. Actual mJOA scores were also determined at each follow-up. Recall error (RE) was defined as the difference between recalled mJOA score at each post-operative visit and the actual baseline score. Age, gender, surgical segments, hospital length of stay, actual mJOA scores at follow-up, and actual rate of improvement in mJOA score were analyzed as predictors of recall accuracy. Descriptive statistics were collected to profile the characteristics of patients enrolled in the study cohort. All statistical computing and graphing were performed with R software and generalized estimating equation (GEE) model fitting was done using geepack package. RESULTS: A total of 105 patients (56.2% of males and 43.8% of females) were enrolled in the study. The median ± SD (range) age at the pre-surgical baseline measurement was 50 ± 8 (25 - 78) years. The recalled mJOA scores at the three follow-up time points were lower than the actual mJOA scores. The recall accuracy gradually decreased over time. Estimated coefficients showed that all variables in the GEE model except for surgical fusion segments were significant (P < 0.05). The pre-operative actual baseline mJOA score was inversely associated with RE. An increasing actual mJOA score over time had a significant positive influence on RE. Greater RE was found in males compared to females. Unexpectedly, age was inversely associated with RE. CONCLUSIONS: The RE increases with the time interval between pre-surgical measurement and post-surgical follow-up and is more prominent in male DCMs patients following upper spine surgery. RELEVANCE FOR PATIENTS: It is necessary to select post-operative patients who need to pay attention according to the three factors of post-operative time, gender, and age, that is, patients with large RE should be given early or timely psychological counseling and treatment concerns, so as to reduce the occurrence of potential medical disputes and improve the level of medical safety.
背景与目的:改良日本骨科协会(mJOA)量表是用于评估退行性颈椎脊髓病(DCM)患者神经功能的主要指标之一。与一些报道相反,mJOA并非基于患者报告的结果,因为它是由医生、专职医疗人员或经过培训的工作人员进行的评估。迄今为止,尚未对DCM患者术前神经功能经mJOA量表评估后的术后回忆准确性进行研究。因此,本研究旨在评估使用mJOA量表时DCM患者的回忆准确性。 方法:本研究分析了2012年2月至2017年8月期间在一个大型学术性脊柱中心由单一外科医生进行颈椎前路椎间盘切除融合术的DCM患者的回忆能力。在术后3个月、12个月和24个月时,使用mJOA量表评估患者对术前神经功能的回忆情况。每次随访时还确定实际的mJOA评分。回忆误差(RE)定义为每次术后随访时回忆的mJOA评分与实际基线评分之间的差异。分析年龄、性别、手术节段、住院时间、随访时实际的mJOA评分以及mJOA评分的实际改善率作为回忆准确性的预测因素。收集描述性统计数据以描述纳入研究队列的患者特征。所有统计计算和绘图均使用R软件完成,使用geepack软件包进行广义估计方程(GEE)模型拟合。 结果:共有105例患者(男性占56.2%,女性占43.8%)纳入研究。术前基线测量时的中位年龄±标准差(范围)为50±8(25 - 78)岁。三个随访时间点回忆的mJOA评分均低于实际mJOA评分。回忆准确性随时间逐渐降低。估计系数显示,GEE模型中除手术融合节段外的所有变量均具有统计学意义(P < 0.05)。术前实际基线mJOA评分与RE呈负相关。随着时间推移实际mJOA评分的增加对RE有显著的正向影响。男性的RE高于女性。出乎意料的是,年龄与RE呈负相关。 结论:RE随着术前测量与术后随访之间的时间间隔增加而增加,在上颈椎手术后的男性DCM患者中更为突出。 对患者的意义:有必要根据术后时间、性别和年龄这三个因素选择需要关注的术后患者,即对RE较大的患者应尽早或及时给予心理辅导和治疗关注,以减少潜在医疗纠纷的发生,提高医疗安全水平。
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