Related Experiment Video
Updated: Jun 20, 2025
Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity
Published on: June 12, 2019
Reliability and validity of the pediatric adaptation of the mJOA scale for evaluating cervical spine disorders
Olga M Sergeenko1, Dmitry M Savin2, Alexey V Evsyukov2
1Division of Spinal Surgery, Ilizarov Center, Kurgan, Russia. pavlova.neuro@mail.ru.
Insights
The pediatric modified Japanese Orthopedic Association (mJOA) scale is a reliable and valid tool for assessing children with cervical spine disorders. This validated scale aids clinical practice and research for pediatric cervical spine conditions.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Spine Surgery
Background:
- Cervical spine disorders in children require accurate assessment tools.
- The Japanese Orthopedic Association (mJOA) scale is widely used in adults.
- A pediatric adaptation is needed for evaluating pediatric cervical spine conditions.
Purpose of the Study:
- To evaluate the validity and reliability of the pediatric adaptation of the mJOA scale.
- To assess its suitability for pediatric patients with diverse cervical spine pathologies.
Main Methods:
- Inter-rater and intra-rater reliability were tested.
- Known-groups validity was assessed by comparing patient groups with different prognoses.
- Concurrent validity was evaluated against the McCormick scale.
- Convergent validity was tested against the adult mJOA scale.
Main Results:
- The study included 169 pediatric patients (6 months to 18 years).
- The pediatric mJOA scale demonstrated high inter-rater (r=0.99) and strong intra-rater (r=0.82) reliability.
- Significant differences were found between patient groups based on neurological status (p<0.0001).
- Strong correlations were observed with the McCormick scale (r=0.97) and adult mJOA scale (r=0.82).
Conclusions:
- The pediatric mJOA scale is a reliable and valid instrument.
- It is suitable for assessing pediatric patients with cervical spine disorders.
- The scale supports use in clinical practice and research for pediatric cervical spine conditions.
Purpose:
The study aimed to evaluate the validity and reliability of the pediatric adaptation of the Japanese Orthopedic Association (mJOA) scale in pediatric patients with various cervical spine pathologies.
Methods:
Initial assessments were performed by a neurosurgeon, followed by an independent evaluation by a neurologist within 1-2 days to test inter-rater reliability. The same clinician assessed the same group of children using the adapted mJOA scale at different point in time (between 1 month and 1 year after the initial assessment) to test intra-rater reliability. For known-groups validity, the pediatric mJOA scale assessments were compared between two groups of pathologies with different prognosis. Concurrent validity was assessed against the McCormick scale, and convergent validity was tested by reassessing patients using the adult mJOA scale two or more years after the initial assessment by pediatric one.
Results:
A cohort of 169 pediatric patients aged 6 months to 18 years (mean age: 10 ± 4.6 years) with various cervical spine pathologies was recruited. Pathologies included atlanto-axial rotatory fixation (AARF), Chiari type I anomaly, congenital cervical spine scoliosis, atlanto-axial dislocation (AAD) and instability (AAI), cervical spine stenosis and trauma, and congenital cervicothoracic dislocations. The majority of patients underwent cervical spine surgery and were followed up for an average of 6.9 ± 2.97 years. The pediatric mJOA scale demonstrated high inter-rater reliability (r = 0.99, p < 0.0001) and strong intra-rater reliability (r = 0.82, p < 0.0001). Significant differences in pediatric mJOA scores were observed between patients with expected-intact neurological status and those with expected-pathological neurological status (p < 0.0001). The pediatric mJOA scale showed a strong correlation with the McCormick grading system (r = 0.97, p < 0.001) and good correlation with the adult mJOA scale during long-term follow-up (r = 0.82, p < 0.0001).
Conclusions:
The pediatric version of the mJOA scale is a reliable and valid tool for assessing pediatric patients with cervical spine disorders. Its high reliability and validity support its use in both clinical practice and research.
