{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:29:33Z","timestamp":1788503373881,"version":"build-2803163510"},"reference-count":122,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Cervical spondylotic myelopathy (CSM) is the most common cause of nontraumatic spinal cord impairment and disability in the world. Given that the Japanese Orthopaedic Association (JOA) score is the most frequently used outcome measure in clinical research and practice for treating patients with CSM, this review was undertaken to comprehensively and critically evaluate the psychometric properties of the JOA score.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors identified studies (published in the period of January 1975 to November 2015) on the psychometric properties of the original, revised, and modified versions of the JOA score in Medline, PsycINFO, Excerpta Medica dataBASE (EMBASE), American College of Physicians Journal Club, and Cochrane Database of Systematic Reviews. Additional publications were captured in a secondary search of the bibliographies in both original research articles and literature reviews identified in the original search. The JOA scores were evaluated for item generation and reduction, internal consistency, reliability, validity, and responsiveness. This review included all those versions of the JOA score whose psychometric properties had been reported in at least 2 published studies.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The primary search strategy identified 59 studies, of which 9 fulfilled the inclusion and exclusion criteria. An additional 18 publications were captured in the secondary search and included in the analysis. The key findings from the 27 studies analyzed indicated the following: 1) the original JOA score (1975) was the source for the revised JOA score (1994) and 3 modified versions (1991, 1993, and 1999 JOA scores) reported or used in at least 2 published studies; 2) the revised and modified versions of the JOA score are markedly different from each other; 3) only the revised JOA score (1994) was validated with the original JOA score; and 4) the 1975 JOA score is the most appropriate instrument for assessing patients in Asian populations (especially from Japan) because of its psychometric attributes, and the 1991 JOA score is the most appropriate version for use in Western populations.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors' results indicate that the original (1975), revised (1994), and modified (1991, 1993, and 1999) versions of the JOA score are substantially different from each other in terms of their content and have been incompletely examined for their psychometric properties and cultural sensitivity. Whereas the 1975 JOA score is the most appropriate version for assessing individuals from Asian populations (particularly those eating with chopsticks), the 1991 JOA score is most suitable for evaluating patients in Western populations. Nonetheless, further investigation of the psychometric properties of the 1975 and 1991 JOA scores is recommended because of a paucity of studies reporting on the responsiveness of these 2 scoring instruments.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.3.focus1648","type":"journal-article","created":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T03:53:12Z","timestamp":1464753192000},"page":"E6","source":"Crossref","is-referenced-by-count":59,"title":["Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy"],"prefix":"10.3171","volume":"40","author":[{"given":"Julio C.","family":"Furlan","sequence":"first","affiliation":[{"name":"Division of Neurology;"},{"name":"Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; and"},{"name":"Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Catharine Craven","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; and"},{"name":"Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus1648","series-title":"World Spinal Column J","first-page":"91","article-title":"Measuring motor, sensory and sphincter dysfunctions in patients with cervical myelopathy using the modified Japanese Orthopedic Association (mJOA) score: a validation study","volume":"3","author":"Azimi","year":"2012"},{"key":"b2-focus1648","series-title":"J Clin Epidemiol","first-page":"1204","article-title":"A taxonomy for responsiveness","volume":"54","author":"Beaton","year":"2001"},{"key":"b3-focus1648","series-title":"J Spinal Disord","first-page":"286","article-title":"Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy","volume":"4","author":"Benzel","year":"1991"},{"key":"b4-focus1648","series-title":"BMJ","first-page":"572","article-title":"Cronbach's alpha","volume":"314","author":"Bland","year":"1997"},{"issue":"Suppl 2","key":"b5-focus1648","series-title":"Eur Spine J","first-page":"139","article-title":"Prevalence of cervical spondylotic myelopathy","volume":"24","author":"Boogaarts","year":"2015"},{"key":"b6-focus1648","series-title":"Ann Rheum Dis","first-page":"901","article-title":"Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy","volume":"55","author":"Casey","year":"1996"},{"key":"b7-focus1648","series-title":"Neurosurgery","first-page":"762","article-title":"Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression","volume":"44","author":"Chiles","year":"1999"},{"key":"b8-focus1648","series-title":"Organ Res Methods","first-page":"207","article-title":"Cronbach's coefficient alpha: well known but poorly understood","volume":"18","author":"Cho","year":"2015"},{"key":"b9-focus1648","series-title":"J Neurosurg","first-page":"492","article-title":"Radical resection of intramedullary spinal cord tumors in adults. Recent experience in 29 patients","volume":"63","author":"Cooper","year":"1985"},{"key":"b10-focus1648","series-title":"Coluna\/Columna","first-page":"23","article-title":"Functional assessment of patients with cervical myelopathy who underwent surgical treatment","volume":"13","author":"Coutinho","year":"2014"},{"key":"b11-focus1648","series-title":"Soc Sci Med","first-page":"1003","article-title":"Sickness Impact Profile: the state of the art of a generic functional status measure","volume":"35","author":"de Bruin","year":"1992"},{"key":"b12-focus1648","series-title":"Spine J","first-page":"2589","article-title":"Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy","volume":"14","author":"Ellingson","year":"2014"},{"key":"b13-focus1648","series-title":"J Neurosurg Spine","first-page":"631","article-title":"Correlation between degree of subvoxel spinal cord compression measured with super-resolution tract density imaging and neurological impairment in cervical spondylotic myelopathy","volume":"22","author":"Ellingson","year":"2015"},{"key":"b14-focus1648","series-title":"Clinimetrics","first-page":"141","article-title":"The theory and evaluation of sensibility","author":"Feinstein","year":"1987"},{"key":"b15-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1148","article-title":"Pathomechanism, pathogenesis, and results of treatment in cervical spondylotic myelopathy caused by dynamic canal stenosis","volume":"15","author":"Fukui","year":"1990"},{"key":"b16-focus1648","series-title":"J Orthop Sci","first-page":"348","article-title":"JOA Back Pain Evaluation Questionnaire (JOABPEQ)\/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The report on the development of revised versions. April 16, 2007","volume":"14","author":"Fukui","year":"2009"},{"key":"b17-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"2083","article-title":"A quantitative and reproducible method to assess cord compression and canal stenosis after cervical spine trauma: a study of interrater and intrarater reliability","volume":"32","author":"Furlan","year":"2007"},{"key":"b18-focus1648","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases","volume":"14","author":"Furlan","year":"2011"},{"key":"b19-focus1648","series-title":"J Neurosurg","first-page":"349","article-title":"Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament","volume":"67","author":"Harsh","year":"1987"},{"key":"b20-focus1648","series-title":"Advances in Neurosurgery: Cerebellar Infarct. Midline Tumors. Mininally Invasive Endoscopic Neurosurgery (MIEN)","first-page":"266","article-title":"The European myelopathy score","author":"Herdmann","year":"1994"},{"key":"b21-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"354","article-title":"Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament","volume":"6","author":"Hirabayashi","year":"1981"},{"key":"b22-focus1648","series-title":"J Bone Joint Surg Br","first-page":"1210","article-title":"A simple performance test for quantifying the severity of cervical myelopathy","volume":"90","author":"Hosono","year":"2008"},{"key":"b23-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1283","article-title":"Postoperative 24-hour result of 15-second grip-and-release test correlates with surgical outcome of cervical compression myelopathy","volume":"37","author":"Hosono","year":"2012"},{"key":"b24-focus1648","series-title":"J Bone Joint Surg Br","first-page":"609","article-title":"Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures","volume":"67","author":"Hukuda","year":"1985"},{"issue":"22 Suppl 1","key":"b25-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"S111","article-title":"Ancillary outcome measures for assessment of individuals with cervical spondylotic myelopathy","volume":"38","author":"Kalsi-Ryan","year":"2013"},{"key":"b26-focus1648","series-title":"PLoS One","first-page":"e0123022","article-title":"Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study","volume":"10","author":"Kato","year":"2015"},{"key":"b27-focus1648","series-title":"Schweiz Med Wochenschr","first-page":"1682","article-title":"[Spondylogenic cervical myelopathy: conservative and surgical therapy.]","volume":"123","author":"Keller","year":"1993"},{"key":"b28-focus1648","series-title":"J Neurosurg Spine","first-page":"526","article-title":"Multimodal assessment after surgery for cervical spondylotic myelopathy","volume":"2","author":"King","year":"2005"},{"issue":"2 Suppl","key":"b29-focus1648","series-title":"J Neurosurg","first-page":"180","article-title":"Validity and reliability of the Short Form-36 in cervical spondylotic myelopathy","volume":"97","author":"King","year":"2002"},{"key":"b30-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1271","article-title":"Preference-based quality of life measurement in patients with cervical spondylotic myelopathy","volume":"29","author":"King","year":"2004"},{"key":"b31-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"E23","article-title":"Psychometric properties of the modified Japanese Orthopaedic Association scale in patients with cervical spondylotic myelopathy","volume":"40","author":"Kopjar","year":"2015"},{"key":"b32-focus1648","series-title":"J Am Acad Child Adolesc Psychiatry","first-page":"1524","article-title":"Measures of clinical significance","volume":"42","author":"Kraemer","year":"2003"},{"key":"b33-focus1648","series-title":"J Chronic Dis","first-page":"27","article-title":"A methodological framework for assessing health indices","volume":"38","author":"Kirshner","year":"1985"},{"key":"b34-focus1648","series-title":"Biometrics","first-page":"159","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977"},{"key":"b35-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1479","article-title":"Usefulness of 3-dimensional measurement of ossification of the posterior longitudinal ligament (OPLL) in patients with OPLL-induced myelopathy","volume":"40","author":"Lee","year":"2015"},{"key":"b36-focus1648","series-title":"J Neurosurg Spine","first-page":"104","article-title":"The natural history of cervical spondylotic myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b37-focus1648","series-title":"Spinal Cord","first-page":"361","article-title":"A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients","volume":"35","author":"Moore","year":"1997"},{"key":"b38-focus1648","series-title":"J Orthop Sci","first-page":"218","article-title":"Usefulness of QuickDASH in patients with cervical laminoplasty","volume":"19","author":"Nakamoto","year":"2014"},{"key":"b39-focus1648","series-title":"Eur Spine J","first-page":"1318","article-title":"Validity of the 10-s step test: prospective study comparing it with the 10-s grip and release test and the 30-m walking test","volume":"20","author":"Nakashima","year":"2011"},{"key":"b40-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"108","article-title":"Simple foot tapping test as a quantitative objective assessment of cervical myelopathy","volume":"37","author":"Numasawa","year":"2012"},{"key":"b41-focus1648","series-title":"Psychometric Theory","author":"Nunnally","year":"1994"},{"key":"b42-focus1648","series-title":"Brain","first-page":"101","article-title":"The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis","volume":"95","author":"Nurick","year":"1972"},{"key":"b43-focus1648","series-title":"Brain","first-page":"87","article-title":"The pathogenesis of the spinal cord disorder associated with cervical spondylosis","volume":"95","author":"Nurick","year":"1972"},{"key":"b44-focus1648","series-title":"J Am Med Assoc","first-page":"23","article-title":"Cervical disk lesions","volume":"166","author":"Odom","year":"1958"},{"key":"b45-focus1648","series-title":"J Bone Joint Surg Br","first-page":"215","article-title":"Myelopathy hand. New clinical signs of cervical cord damage","volume":"69","author":"Ono","year":"1987"},{"key":"b46-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"601","article-title":"Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions","volume":"11","author":"Prolo","year":"1986"},{"key":"b47-focus1648","series-title":"J Bone Joint Surg Am","first-page":"1003","article-title":"Cervical spine fusion in rheumatoid arthritis","volume":"61","author":"Ranawat","year":"1979"},{"key":"b48-focus1648","series-title":"Neurol India","first-page":"24","article-title":"Modification of Nurick scale and Japanese Orthopedic Association score for Indian population with cervical spondylotic myelopathy","volume":"63","author":"Revanappa","year":"2015"},{"key":"b49-focus1648","series-title":"Eur Spine J","first-page":"1545","article-title":"Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy","volume":"20","author":"Revanappa","year":"2011"},{"key":"b50-focus1648","series-title":"J Outcome Meas","first-page":"798","article-title":"Comparison of seven different scales used to quantify severity of cervical spondylotic myelopathy and postoperative improvement","volume":"5","author":"Singh","year":"2001\/2002"},{"key":"b51-focus1648","series-title":"Lancet","first-page":"370","article-title":"Quantitative assessment of cervical spondylotic myelopathy by a simple walking test","volume":"354","author":"Singh","year":"1999"},{"key":"b52-focus1648","series-title":"Acta Neurochir (Wien)","first-page":"1235","article-title":"Use of quantitative assessment scales in cervical spondylotic myelopathy\u2014survey of clinician's attitudes","volume":"147","author":"Singh","year":"2005"},{"key":"b53-focus1648","series-title":"Int J Med Educ","first-page":"53","article-title":"Making sense of Cronbach's alpha","volume":"2","author":"Tavakol","year":"2011"},{"key":"b54-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1653","article-title":"The minimum clinically important difference of the Modified Japanese Orthopaedic Association Scale in patients with degenerative cervical myelopathy","volume":"40","author":"Tetreault","year":"2015"},{"key":"b55-focus1648","series-title":"J Manipulative Physiol Ther","first-page":"409","article-title":"The Neck Disability Index: a study of reliability and validity","volume":"14","author":"Vernon","year":"1991"},{"key":"b56-focus1648","series-title":"Eur Spine J","first-page":"2096","article-title":"Analysis of five specific scores for cervical spondylogenic myelopathy","volume":"16","author":"Vitzthum","year":"2007"},{"key":"b57-focus1648","series-title":"Spine J","first-page":"1493","article-title":"Diffusion tensor imaging of somatosensory tract in cervical spondylotic myelopathy and its link with electrophysiological evaluation","volume":"14","author":"Wen","year":"2014"},{"key":"b58-focus1648","series-title":"How to Use the ICF: A Practical Manual for Using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment","author":"World Health Organization","year":"2013"},{"key":"b59-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1890","article-title":"Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy","volume":"26","author":"Yonenobu","year":"2001"},{"key":"b60-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"82","article-title":"\u201cTen second step test\u201d as a new quantifiable parameter of cervical myelopathy","volume":"34","author":"Yukawa","year":"2009"},{"key":"b61-focus1648","series-title":"Eur Spine J","first-page":"2918","article-title":"Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study","volume":"24","author":"Zhou","year":"2015"},{"key":"b1-focus1648","series-title":"World Spinal Column J","first-page":"91","article-title":"Measuring motor, sensory and sphincter dysfunctions in patients with cervical myelopathy using the modified Japanese Orthopedic Association (mJOA) score: a validation study","volume":"3","author":"Azimi","year":"2012"},{"key":"b2-focus1648","series-title":"J Clin Epidemiol","first-page":"1204","article-title":"A taxonomy for responsiveness","volume":"54","author":"Beaton","year":"2001"},{"key":"b3-focus1648","series-title":"J Spinal Disord","first-page":"286","article-title":"Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy","volume":"4","author":"Benzel","year":"1991"},{"key":"b4-focus1648","series-title":"BMJ","first-page":"572","article-title":"Cronbach's alpha","volume":"314","author":"Bland","year":"1997"},{"issue":"Suppl 2","key":"b5-focus1648","series-title":"Eur Spine J","first-page":"139","article-title":"Prevalence of cervical spondylotic myelopathy","volume":"24","author":"Boogaarts","year":"2015"},{"key":"b6-focus1648","series-title":"Ann Rheum Dis","first-page":"901","article-title":"Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy","volume":"55","author":"Casey","year":"1996"},{"key":"b7-focus1648","series-title":"Neurosurgery","first-page":"762","article-title":"Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression","volume":"44","author":"Chiles","year":"1999"},{"key":"b8-focus1648","series-title":"Organ Res Methods","first-page":"207","article-title":"Cronbach's coefficient alpha: well known but poorly understood","volume":"18","author":"Cho","year":"2015"},{"key":"b9-focus1648","series-title":"J Neurosurg","first-page":"492","article-title":"Radical resection of intramedullary spinal cord tumors in adults. Recent experience in 29 patients","volume":"63","author":"Cooper","year":"1985"},{"key":"b10-focus1648","series-title":"Coluna\/Columna","first-page":"23","article-title":"Functional assessment of patients with cervical myelopathy who underwent surgical treatment","volume":"13","author":"Coutinho","year":"2014"},{"key":"b11-focus1648","series-title":"Soc Sci Med","first-page":"1003","article-title":"Sickness Impact Profile: the state of the art of a generic functional status measure","volume":"35","author":"de Bruin","year":"1992"},{"key":"b12-focus1648","series-title":"Spine J","first-page":"2589","article-title":"Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy","volume":"14","author":"Ellingson","year":"2014"},{"key":"b13-focus1648","series-title":"J Neurosurg Spine","first-page":"631","article-title":"Correlation between degree of subvoxel spinal cord compression measured with super-resolution tract density imaging and neurological impairment in cervical spondylotic myelopathy","volume":"22","author":"Ellingson","year":"2015"},{"key":"b14-focus1648","series-title":"Clinimetrics","first-page":"141","article-title":"The theory and evaluation of sensibility","author":"Feinstein","year":"1987"},{"key":"b15-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1148","article-title":"Pathomechanism, pathogenesis, and results of treatment in cervical spondylotic myelopathy caused by dynamic canal stenosis","volume":"15","author":"Fukui","year":"1990"},{"key":"b16-focus1648","series-title":"J Orthop Sci","first-page":"348","article-title":"JOA Back Pain Evaluation Questionnaire (JOABPEQ)\/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The report on the development of revised versions. April 16, 2007","volume":"14","author":"Fukui","year":"2009"},{"key":"b17-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"2083","article-title":"A quantitative and reproducible method to assess cord compression and canal stenosis after cervical spine trauma: a study of interrater and intrarater reliability","volume":"32","author":"Furlan","year":"2007"},{"key":"b18-focus1648","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases","volume":"14","author":"Furlan","year":"2011"},{"key":"b19-focus1648","series-title":"J Neurosurg","first-page":"349","article-title":"Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament","volume":"67","author":"Harsh","year":"1987"},{"key":"b20-focus1648","series-title":"Advances in Neurosurgery: Cerebellar Infarct. Midline Tumors. Mininally Invasive Endoscopic Neurosurgery (MIEN)","first-page":"266","article-title":"The European myelopathy score","author":"Herdmann","year":"1994"},{"key":"b21-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"354","article-title":"Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament","volume":"6","author":"Hirabayashi","year":"1981"},{"key":"b22-focus1648","series-title":"J Bone Joint Surg Br","first-page":"1210","article-title":"A simple performance test for quantifying the severity of cervical myelopathy","volume":"90","author":"Hosono","year":"2008"},{"key":"b23-focus1648","series-title":"Spine (Phila Pa 1976)","first-page":"1283","article-title":"Postoperative 24-hour result of 15-second grip-and-release test correlates with surgical outcome of cervical compression myelopathy","volume":"37","author":"Hosono","year":"2012"},{"key":"b24-focus1648","series-title":"J Bone Joint Surg Br","first-page":"609","article-title":"Operations for cervical spondylotic myelopathy. 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