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OBJECTIVE: Hand clumsiness and reduced hand dexterity can signal early signs of degenerative cervical myelopathy (DCM). While the 10-second grip and release (10-s G&R) test is a common clinical tool for evaluating hand function, a more accessible method is warranted. This study explores the use of deep learning-enhanced hand grip and release test (DL-HGRT) for predicting DCM and evaluates its capability to reduce the duration of the 10-s G&R test. METHODS: The retrospective study included 508 DCM patients and 1,194 control subjects. Propensity score matching (PSM) was utilized to minimize the confounding effects related to age and sex. Videos of the 10-s G&R test were captured using a smartphone application. The 3D-MobileNetV2 was utilized for analysis, generating a series of parameters. Additionally, receiver operating characteristic curves were employed to assess the performance of the 10-s G&R test in predicting DCM and to evaluate the effectiveness of a shortened testing duration. RESULTS: Patients with DCM exhibited impairments in most 10-s G&R test parameters. Before PSM, the number of cycles achieved the best diagnostic performance (area under the curve [AUC], 0.85; sensitivity, 80.12%; specificity, 74.29% at 20 cycles), followed by average grip time. Following PSM for age and gender, the AUC remained above 0.80. The average grip time achieved the highest AUC of 0.83 after 6 seconds, plateauing with no significant improvement in extending the duration to 10 seconds, indicating that 6 seconds is an adequate timeframe to efficiently evaluate hand motor dysfunction in DCM based on DL-HGRT. CONCLUSION: DL-HGRT demonstrates potential as a promising supplementary tool for predicting DCM. Notably, a testing duration of 6 seconds appears to be sufficient for accurate assessment, enhancing the test more feasible and practical without compromising diagnostic performance.
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STUDY DESIGN: Diagnostic accuracy study with prospectively collected data. OBJECTIVE: This study aimed to establish optimal cutoff values for the 10-second grip and release (10s-G&R) Test to distinguish between mild, moderate, and severe levels of hand dexterity impairment in patients with degenerative cervical myelopathy (DCM). BACKGROUND: The 10s-G&R test is widely utilized to assess hand function in DCM patients. However, whether this test can effectively distinguish between varying severities of hand dexterity impairment, along with the relevant cutoff values, remains unknown. MATERIALS AND METHODS: The authors analyzed hand motion data from 551 consecutively enrolled DCM patients using an artificial intelligent system. In addition, the authors conducted evaluations of functional status, quality of life, and outcome measures. Receiver operating curve analysis was performed to determine cutoff values that differentiate mild, moderate, and severe hand dexterity impairments based on the ability to fasten buttons, as assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Q2-1. The validity of these cutoffs was assessed by comparing G&R parameters, upper limb disability, overall disease severity, and quality of life among patients in different severity groups. RESULTS: The authors identified 16 G&R cycles as the cutoff for moderate hand dexterity impairment and 13 G&R cycles as the cutoff for severe impairment. Patients with severe impairment exhibited significantly worse G&R parameters, more severe upper limb symptoms, greater overall disease severity, and reduced quality of life. Patients completing fewer than 13 G&R cycles within 10 seconds were more likely to have moderate-to-severe DCM, indicating the need for potential surgical intervention. CONCLUSION: The authors propose classifying mild hand dexterity impairment as 17 to 20 cycles on the 10s-G&R test, moderate as 14 to 16 cycles, and severe as 13 cycles or less. Our study underscores that the 10s-G&R test can serve as an effective supplementary tool within the context of other currently available measurement tools.
