Psychometric Performance of Clinician- and Patient-Reported Outcome Measures in Surgically Treated Thoracic Myelopathy: A Multicenter Prospective Study
So Kato, Naohiro Kawamura, Yu Yamato, Yoichi Iizuka, Tomoyuki Takigawa, Michio Hongo, Masanari Takami, Shinji Takahashi, Jun Takahashi, Mitsuru Fukui, Miho Sekiguchi, Shota Ikegami, Hiroshi Hashizume, Hirotaka Chikuda, Kei Watanabe, Tsukasa Kanchiku, Masahiro Kanayama, Yasuo ItoStudy Design
Multicenter prospective observational study.
Objectives
To determine the responsiveness, reliability, and construct validity of commonly used clinician-reported and patient-reported outcome measures in surgically treated thoracic myelopathy, a condition for which standardized outcome assessment has not been established.
Methods
Adults undergoing surgery for MRI-confirmed thoracic myelopathy were prospectively enrolled at nine tertiary centers. Clinician-reported measures included the Japanese Orthopaedic Association (JOA) score, a thoracic-adapted JOA subtotal (JOAt), and the modified JOA (mJOA). Patient-reported outcomes included the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and EuroQOL 5-dimension (EQ-5D). Assessments were performed preoperatively and at 3–6 months postoperatively. Internal responsiveness was evaluated using Wilcoxon’s r, test–retest reliability using ICC(1,1), and construct validity using Spearman’s correlation with EQ-5D.
Results
Fifty-one patients were included (mean age 65.6 years; 59% male). Significant postoperative improvement was observed across major clinician-reported and patient-reported outcomes. Large internal responsiveness was demonstrated for JOA (r=0.64), JOAt (0.63), mJOA (0.68), and JOACMEQ lower-extremity function (LF) (0.59). Test–retest reliability was high for JOA, JOAt, mJOA, JOACMEQ-LF, and EQ-5D (ICC range 0.78–0.85). JOACMEQ-LF showed the strongest construct validity with EQ-5D at both baseline (ρ=0.62) and follow-up (ρ=0.72).
Conclusions
JOAt, mJOA, and JOACMEQ lower-extremity function demonstrated robust psychometric performance in thoracic myelopathy. These measures represent suitable candidates for standardized outcome assessment and provide a methodological foundation for future clinical studies and guideline development in this under-studied condition.