Telephone scoring proves reliable for assessing cervical myelopathy in trials

A telephone version of the modified Japanese Orthopaedic Association (mJOA) score, the gold-standard measure of neurological functional impairment in degenerative cervical myelopathy (DCM), has been validated in a study published in Acta Neurochirurgica. Although the mJOA was designed for face-to-face clinical use, telephone administration became common after the shift to telemedicine during the COVID-19 pandemic. The new analysis, drawing on the ongoing POLYFIX-DCM randomised controlled trial of laminectomy with or without fusion for multilevel DCM, set out to evaluate whether assessments conducted over the phone can stand in for in-person examinations.

The researchers analysed two prespecified cohorts. In the multicentre NIHR POLYFIX-DCM cohort, face-to-face assessments performed by site investigators at enrolment or before surgery were compared with a centralised telephone assessment carried out by a small group of investigators, a design intended to enable blinded outcome assessment and centralised follow-up. In the single-centre Cambridge cohort, both the face-to-face and telephone assessments were performed by the same investigators, removing variation between assessors.

Agreement between the paired assessments was evaluated using Bland–Altman analysis, the intra-class correlation coefficient (ICC), and the proportion of pairs falling within ±1 mJOA point, which was the predefined acceptability threshold. Reliability was judged against a prespecified criterion of ICC ≥ 0.70. Sensitivity analyses examined whether results varied by site, age, severity, and timing of the assessments.

In the multicentre cohort, 179 paired assessments produced a mean difference of +0.24 points between the face-to-face and telephone scores, with a 95% confidence interval of −0.02 to 0.50, and an ICC of 0.69 (95% CI 0.60–0.76). The majority of pairs fell within the accepted ±1-point threshold. In the single-centre cohort of 26 pairs, agreement was markedly higher, with an ICC of 0.97 (95% CI 0.93–0.98) and 96% of pairs within ±1 point. Bland–Altman plots showed no systematic bias, and agreement did not vary by site, age, or time.

The authors conclude that these findings support the validity of telephone-administered mJOA assessment, particularly when undertaken by trained assessors using a standardised approach, and that it may be a useful method for remote outcome assessment in DCM trials such as POLYFIX-DCM. The slightly lower ICC in the multicentre cohort, just below the prespecified 0.70 reliability threshold, contrasts with the near-perfect agreement seen when the same investigators performed both assessments, suggesting that assessor consistency contributes to measurement agreement. The article is published open access as an accepted, citable version of record in progress.

Subject of Research: Validation of telephone-administered mJOA scoring for degenerative cervical myelopathy

Article Title: Validity of a telephone administered modified Japanese orthopaedic association score for degenerative cervical myelopathy

Article References: Chedid, Y., Yordanov, S., Mowforth, O. D., Gillespie, C. S., Gardner, A., Vergara, P., Deakin, N., Ivanov, M., Srinivas, S., Demetriades, A. K., Krivankova, B., Sheikh, M. E., Barrett, C., Czyz, M., Arora, M., Burgula, M. V., Dea, N., Grassner, L., George, J., … Davies, B. M. (2026). Validity of a telephone administered modified Japanese orthopaedic association score for degenerative cervical myelopathy. Acta Neurochirurgica. https://doi.org/10.1007/s00701-026-07065-1

Image Credits: AI Generated

DOI: 10.1007/s00701-026-07065-1

Keywords: degenerative cervical myelopathy, mJOA score, telephone assessment, telemedicine, POLYFIX-DCM trial, intra-class correlation, Bland-Altman analysis, outcome measures, neurosurgery, validation study, Validity, telephone