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Assessment Scales

Assessment Scales

What are they?

Scoring systems are tools used to produce a measure (often a number or grade) of how affected something is. There are a number of different scoring systems which are used in myelopathy as we outline below. Some of the key points to understand are:

Important Points to Understand: 

1) Not all tools are designed to measure the same thing: some tools measure just a single aspect of myelopathy, whilst others measure multiple features of myelopathy. Some tools have been specifically designed for use in myelopathy, whilst others have been repurposed from other areas of health.

Vertigo

2) Interpreting these tools can be complicated….

a. No tool is perfect: All tools have the positives and negatives; for example, they may compromise on the detail and subtlety of measurements, to be shorter and easier to complete. All of these factors have a role in their accuracy and utility.

b. Be mindful of the numbers: most of these scoring systems use categories developed by researchers, which are then assigned a number. We are used to understanding numbers as a linear scale, i.e. 1 + 1 = 2, i.e. 2 is twice as big as 1. However, in the scoring systems, numbers and categories do not necessarily equate in this simple linear way. Therefore, a change in number or category could mean a very small change or a very large change in myelopathy.

3) Scoring systems are principally used for research but are increasingly used in routine practice. Scoring systems are most commonly used in research studies, to objectively and more accurately, track changes to your symptoms over time, perhaps in response to a treatment. However, they are increasingly being used in normal routine care for the same reasons.

How are scoring systems completed?

How the scoring system is completed will depend on the system. Many are simply completed by the doctor, based on the general information you have provided during your consultation, whereas others require answers to very specific questions. Some tools are instead completed by the patient themselves. Time to complete the assessment will vary depending on the scoring system used but may be anywhere from 2 minutes to 45 minutes. Below are details on some of the most common myelopathy scoring systems. All the systems tend to use questions assessing activities in your everyday life to assess how your myelopathy is affecting you.

mJOA

The modified Japanese Orthopaedic Association (mJOA) scoring system is scored from 0 to 18 points. A lower score represents more severe myelopathy than a higher score. A score of 15-17 represents mild, 12-14 moderate and 0-11 severe myelopathy. The mJOA comprises four parts: movement in the arms, movement in the legs, feeling in the arms and bladder control, as shown below. Questions focus on everyday examples of how your myelopathy may be affecting you such as how well you can button your shirt, eat with a spoon, walk, feel using your hands and control your bladder.

The mJOA is used in the international guidelines for management of DCM.  They use the scoring system to represent the severity of myelopathy and advise on the best treatment strategy, principally a decision between watchful waiting with or without physiotherapy, and surgery.

Nurick Score

The Nurick scoring system focusses on walking. There scale has 6 grades from 0 to 5, as shown below. In contrast to the mJOA, a higher Nurick score corresponds with more severe myelopathy. Your doctor will assess if you have any difficulties with you walking and will ask if any difficulties you have are affecting your work or causing you to need help with your walking from others.nurick score

​Numeric Pain Rating Scale

The Numeric Pain Rating Scale is used to assess the severity of pain across many areas of medicine. Your doctor will ask you to rate your pain on a scale of 0-10, with 0 being no pain at all and 10 being the worst pain you can imagine. Your doctor may ask you verbally or give you a visual scale (as shown below) on which to mark your score.

Neck Disability Index

The Neck Disability Index scoring system assesses how your neck pain is affecting your everyday life. There are ten sections covering pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation. Within each section there are several statements; you should mark the one statement that is the best description of how your neck pain is affecting you. Using your responses your doctor will calculate a total score out of 50 and may double this to give a percentage score out of 100. This score will give your doctor a better idea of how much disability your neck pain is causing you. A higher score means more disability.

Download the Neck Disability Index

Myelopathy Disability Index

The Myelopathy Disability Index is a disability scoring system for myelopathy caused by rheumatoid arthritis. The assessment consists of 10 questions, each with a possible score of 0-3 points, giving a total score out of 30. Questions focus on getting out of bed and chairs, eating, walking, hygiene, grip and daily activities. The higher the score the higher your disability.myelopathy disability index

Spinal Cord Independence Measure (v III)

The Spinal Cord Independence Measure VIII is a disability scoring system for patients with spinal cord injury. The questions focus on everyday functioning such as self-care (feeding, grooming, bathing, dressing), bladder and bowel control, breathing and mobility. The total score is out of 100, with lower scores corresponding to more disability.

​Odom's Recovery Scale

Odom’s Recovery scale may be used to score your myelopathy following surgery. Your recovery will be scored as excellent, good, fair or poor using the criteria shown below. Your score will be determined by your symptoms and your doctor’s examination findings following surgery compared to before surgery.

odoms recovery scale

Written by O.D. Mowforth
Reviewed by B.M. Davies