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)
Overall ranking	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.
Evidence	No systematic reviews or guidelines identified. Kalsi-Ryan S, Singh A, Massicotte EM, Arnold PM, Brodke DS, Norvell DC, Hermsmeyer JT, Fehlings MG. Ancillary outcome measures for assessment of individuals with cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S111-22. Singh A, Tetreault L, Casey A, Laing R, Statham P, Fehlings MG. A summary of assessment tools for patients suffering from cervical spondylotic myelopathy: a systematic review on validity, reliability and responsiveness. Eur Spine J. 2015 Apr;24 Suppl 2:209-28.
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?
Submitted by	Spinal Surgeons x 36, Other healthcare professionals x 18, People with DCM and their supporters x 9

PSP information
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