The Use of a Novel Tablet Application to Quantify Dysfunction in Cervical Spondylotic Myelopathy Patients

Publication date: Available online 23 August 2018

Source: The Spine Journal

Author(s): Brett D. Rosenthal, Tyler J. Jenkins, Arjun Ranade, Surabhi Bhatt, Wellington K. Hsu, Alpesh A. Patel

Abstract

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 (e.g., pathologic reflexes, gait disturbance) and subjective scoring systems (e.g., 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 to agematched, healthy, 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 fine motor skills (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<0.0001). 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 4 challenges < 0.001). Based upon the 15 control subjects who repeated FiMS testing four sequential times, intra-rater 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 to an age-matched control cohort. This is true for all 4 challenges in the FiMS tablet application. The test can be completed in under 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.

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