Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 3, 2025
Date Accepted: Jun 18, 2026
Towards the Optimal Way to Assess Symptomatic Fatigue in Degenerative Cervical Myelopathy: A Preliminary Mixed Method Survey Study to Inform Content Validity
ABSTRACT
Background:
Recent work has demonstrated that individuals with degenerative cervical myelopathy (DCM) often experience symptoms of fatigue which is under appreciated in the literature. Conversely, it is highly valuable to people living with DCM. The AO Spine RECODE-DCM study group recently determined no suitable fatigue scales exist for DCM.
Objective:
An assessment of content validity of existing fatigue scales used in other populations was undertaken to determine if any such scales are suitable for DCM.
Methods:
An expert panel of people with DCM (PwDCM) was convened. PwDCM were members of the RECODE-DCM steering committee, ranged in severity from mild to severe myelopathy, and resided in the United Kingdom or the United States of America. 19 instruments in use for other pathologies were presented. A quantitative description of relevance to DCM was reported by PwDCM. Likewise, PwDCM scored each scale on clarity, and comprehensiveness. A preliminary qualitative analysis of comments on the various attributes of the respective instruments to establish themes distinguishing high-scoring instruments from lower-scoring instruments was assessed.
Results:
The highest scoring scales were 1) modified fatigue impact scale for SCI (scored Relevance=3.78, Comprehensiveness=3.56, Clarity=4 respectively), 2) multidimensional assessment of fatigue (scored 3.67, 3.56, and 3.89 respectively), and 3) functional assessment of chronic illness therapy: fatigue scale (scored 3.56, 3.56, and 3.89 respectively). Common themes used in discussing various instruments were sleep, pain, psychosocial factors, and employment.
Conclusions:
The Modified Fatigue Impact Scale for Spinal Cord Injury, Multidimensional Assessment of Fatigue, and Functional Assessment of Chronic Illness Therapy-Fatigue Scale appear to be the most appropriate and validated instruments for assessing fatigue in patients with DCM. These scales demonstrate strong psychometric properties while addressing the unique symptomatic profile and functional limitations characteristic of DCM, enabling more accurate measurement and clinical monitoring of fatigue in this patient population.
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