The use of a novel tablet application to quantify dysfunction in cervical spondylotic myelopathy patients

Background Context: Despite the prevalence and importance of myelopathy, there is a paucity of objective and quantitative clinical measures. The most commonly used diagnostic tools available are nonquantitative physical exam findings (eg, pathologic reflexes, and gait disturbance) and subjective scoring systems (eg, modified Japanese Orthopaedic Association [mJOA]). A decline in fine motor coordination is a hallmark of early myelopathy, which may be useful for quantitative testing. Purpose: To identify if a novel tablet application could provide a quantitative measure of upper extremity dysfunction in cervical spondylotic myelopathy. Study Design/Setting: Prospective cohort study Patient Sample: Adult patients with a diagnosis of cervical spondylotic myelopathy from a board-certified, spine surgeon were compared with age-matched, healthy, and adult control patients. Outcome Measures: Self-reported function was assessed via the mJOA. Upper extremity function was measured via the fine motor skills (FiMS) tablet test. Methods: Subjects and controls prospectively completed the mJOA paper survey and the FiMS tablet testing, which consisted of four challenges. Results: After age-matching, 65 controls and 28 myelopathic patients were available for comparison. The mean mJOA was 13.5 ± 2.9 in the myelopathic cohort and 17.3 ± 1.1 in the control cohort (p <.0001). The average scores for challenges 1–4 in control patients were 24.4, 16.3, 3.2, and 6.6, respectively, whereas the average scores for the myelopathic patients were 16.6, 10.5, 1.4, and 1.8, respectively (p values for all four challenges <.001). Based upon the 15 control subjects who repeated FiMS testing four sequential times, intrarater reliability was excellent, yielding an interclass correlation coefficient of 0.88 Conclusions: The FiMS tablet application produced significantly lower scores in a myelopathic cohort when compared with an age-matched control cohort. This is true for all four challenges in the FiMS tablet application. The test can be completed in 1.5 minutes, producing a reliable, quantitative measure of cervical myelopathy upper extremity function. In summary, the FiMS tablet application is a novel, easily administered, objectively quantifiable test for analyzing cervical spondylotic myelopathy.