Assessment and monitoring
Podcast Episode 4: Assessment and monitoring
In Episode 4 Michelle Starkey and Ben Davies talk about techniques for Assessment and Monitoring of DCM. First they hear Paige Howard's perspective as someone living with DCM. Then, Spine Surgeon Paul Koljonen and Rehabilitation Specialist Sukhvinder Kalsi-Ryan give their expert input regarding current techniques, critical knowledge gaps and recent innovations in the field.
Current evidence and reason for uncertainties
No systematic reviews or guidelines identified.
Relevant literature reviews
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.
Source of uncertainty
* This list shows the original survey submission(s) that informed the indicative uncertainties and the resulting priority question.
Scales (Nurrick, JOA etc.) used in the evaluation of DCM patients include generalizations. Therefore, it is not possible to evaluate small developments in postoperative follow-up and evaluations made with current scales cannot show the developments. Can there be more detailed scales for postoperative development and follow-up?
What constitutes progression? History, physical, functional measures
Suggest work to develop an assessment tool to monitor. This could be analogous to the ALS (Amyotrophic lateral Sclerosis) Functional Rating Scale that researchers as well as managing physicians could use.
What to monitor with clinic, mri, sseps.
What are the best outcome measures for this population?
What are the optimal scales for assessing the quality of life due to DCM?
How to evaluate the effectiveness of treatment and the rate of disease progression? What is more important the subjective assessment of the result by the patient or objective data?
I like the idea of using wearable tech to measure outcomes and woudl liketo see this move from teh research to NHS sphere.
Can an objective method be developed to detect myelopathic worsening in DCM?
The role of wearable smart devices to monitor patients with early DCM, Monitor early intervention versus late intervention, and the use of these devices to assist in rehabilitation of these patients as they are a difficult cohort to look after.
What the the monitoring scale for assessing response to treatment for a patient with DCM?
What is the best method for monitoring a patients response to treatment?
How can we best monitor DCM?
What are the best PROMs for assessing DCM?
What is the best method of monitoring a person with DCM‘s response to treatments
How can we document changes and fluctuations to support care of this condition.
What signs? symptoms? are most useful in monitoring the progression?
The activities of daily living should be monitored on regular basis.
How could we have a better sensibilization for the mielopathy progression / recovery?
What is the best instrument to assess outcome after surgery?
Since so many with DCM can continue to deteriorate after surgery what screening tools can be used to determine if symptoms are part of previous injury or might be a sign of worsening damage that needs treatment?
Most important outcomes for follow up
Can transcranial MEP pre op and post op be used to monitor response to treatment?
Better monitoring of declining patients?
Is there a better patient questionnaire instrument that helps assess most/all aspects of the patient as affected by DCM?
What is the best way for the patient to monitor DCM changes so she can report her symptoms with accuracy rather than repetitiveness? I am thinking of a scale similar to pain management.
What is the best method of monitoring a person
How frequently should patients be monitored? Are there questionnaires/symptom scoring sheets that can help to determine whether patients need to be referred to secondary care?
Monitoring parameters to assess the improvement in DCM clinically
What is the best method of assessing the neurological recovery after surgical decompression in DCM?
Preoperative evaluation methods ( modified JOA or NUrick) are already exist, but sometime i meet some difficulties to use them due to some unclarity and not fully reflect patients status
What is the best method of monitoring DCM patients' response treatment?
What is the disability questionnaire useful to measure the evolution of a DCM
Can we better define patient outcomes in DCM, and particularly patient-important outcomes?
What are the primary measures we should follow for outcomes?
Are there any "smart technology gadgets" that can help DCM patients either pre or post operatively? (for example: Smart watches to analyze gait/imbalance or falls).
What is the best method to monitor disease progression?
How to validate the severity of DCM?
Are their standard tests and measures that should be utilized with DCM patients to determine staging/ severity of disease, assess function, overall health status, etc?
Definition of functional impairment
Ambulatory neurological monitoring
How can the degenerative aspect of DCM be measured/quantified?
Is there a scale on which to measure the severity of DCM
What is the best way to classify the severity of disease and incorporate functional impairment and level of compression and its associated co-morbidiites?
Our field needs clinical grading scales that are more granular and objective than the mJOA
Severity of DCM- Classification and its relationship with treatment modalities
Do certain biomarkers correlate with DCM severity?
Are current clinical scales (JOA, Nurick) helpful in the diagnosis and follow up of patients or do we need new ones
What is the most reliable patient reported outcome measure in the management of DCM?
Which is the best way to objectively asses/rate imbalance and clumsiness?
Grading of myelopathy
How to precisely evaluate the severity of DCM?
Is is possible to develop enhanced tools to determine if further degeneration is likely in a patient at a much earlier stage ?
What criteria can we use to determine "success"? MCID Change in mJOA?
How can we develop an objective measure of severity of myelopathy?
The role of objective measurement tools (gait velocity, step length, gait smoothness) in the management of DCM
How could we decide wich one is the most important in outcomes?
Do the currently widely used severity scoring symptoms correlate with patient reported outcome?
What is the best outcome scale or test to quantify evolution or progression of DCM