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Review
. 2022 Mar;8(1):149-162.
doi: 10.21037/jss-21-109.

Gait assessment tools for degenerative cervical myelopathy: a systematic review

Wen Jie Choy  1   2 , Lingxiao Chen  3 , Camila Quel De Oliveira  4 , Arianne P Verhagen  4 , Omprakash Damodaran  2 , David B Anderson  5   6
Affiliations
Review

Gait assessment tools for degenerative cervical myelopathy: a systematic review

Wen Jie Choy et al. J Spine Surg. 2022 Mar.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Discussion: 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.

Keywords: Measurement properties; cervical myelopathy; cervical spondylosis; gait assessment; spinal stenosis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-21-109/coif). The series “Objective Monitoring and Wearable Technologies including Sensor-Based Accelerometers and Mobile Health Applications for the Spine Patient” was commissioned by the editorial office without any funding or sponsorship. WJC serves as an Assistant Managing Editor of Journal of Spine Surgery. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart outlining the process in this systematic review. Based upon the PRISMA preferred reporting for Systematic reviews.
See this image and copyright information in PMC

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