Priority 4 from the Degenerative Cervical Myelopathy PSP
|UNCERTAINTY: How can the severity of DCM be evaluated? What assessment tools can be used to evaluate functional impairment, disability and quality of life in patients with DCM? What instruments, tools or methods can be used or developed to monitor DCM patients for disease progression or improvement either before or after surgical treatment? Is there a role for smart-technology? (JLA PSP Priority 4)|
|JLA question ID||0097/4|
|Explanatory note||Quantitative tools are valuable in the clinical setting because they can be used to objectively describe disease severity, assess the effective of interventions, predict outcome and provide decision support to clinicians. Several tools have developed to evaluate neurological impairment, functional status and health-related quality of life in patients with DCM. The current gold standard for the assessment of patients with DCM is the modified Japanese Orthopedic Association (mJOA) scale. This scale is a clinician-administered tool that separately addresses the motor function of the upper and lower extremities, sensory function and bladder function. The disadvantages of this score are (i) it exhibits a ceiling effect making it difficult to detect minor improvements in patients with mild myelopathy; (ii) it does not include pain which is a relevant symptom in many patients with DCM; (iii) the four categories are not equally weighted; and (iv) its reliability has not been established. Further research is required to develop an "easy to use" and relevant tool that can detect small improvements in functional status or disease progression. No studies have evaluated the role for smart-technology.|
No systematic reviews or guidelines identified.
|Health Research Classification System category||Neurological|
|Extra information provided by this PSP|
|Original uncertainty examples||
What are the best PROMs for assessing DCM? ~ What are the best outcome measures for this population? ~ What is the best method of monitoring a person with DCM‘s response to treatments? ~ What is the best method to monitor disease progression? ~ What is the most reliable patient reported outcome measure in the management of DCM? ~ How to precisely evaluate the severity of DCM?
Spinal Surgeons x 36, Other healthcare professionals x 18, People with DCM and their supporters x 9
|PSP unique ID||0097|
|PSP name||Degenerative Cervical Myelopathy|
|Total number of uncertainties identified by this PSP.||76 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)|
|Date of priority setting workshop||20 November 2019|