title: Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study.
abstract: OBJECTIVE
  The Japanese Orthopaedic Association (JOA) score is widely used to assess the severity of clinical symptoms in patients with cervical compressive myelopathy, particularly in East Asian countries. In contrast, modified versions of the JOA score are currently accepted as the standard tool for assessment in Western countries. The objective of the present study is to compare these scales and clarify their differences and interchangeability and verify their validity by comparing them to other outcome measures.
  
  
  METHODS
  Five institutions participated in this prospective multicenter observational study. The JOA and modified JOA (mJOA) proposed by Benzel were recorded preoperatively and at three months postoperatively in patients with cervical compressive myelopathy who underwent decompression surgery. Patient reported outcome (PRO) measures, including Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), the Short Form-12 (SF-12) and the Neck Disability Index (NDI), were also recorded. The preoperative JOA score and mJOA score were compared to each other and the PRO values. A Bland-Altman analysis was performed to investigate their limits of agreement.
  
  
  RESULTS
  A total of ninety-two patients were included. The correlation coefficient (Spearman's rho) between the JOA and mJOA was 0.87. In contrast, the correlations between JOA/mJOA and the other PRO values were moderate (|rho| = 0.03 - 0.51). The correlation coefficient of the recovery rate between the JOA and mJOA was 0.75. The Bland-Altman analyses showed that limits of agreement were 3.6 to -1.2 for the total score, and 55.1% to -68.8% for the recovery rates.
  
  
  CONCLUSIONS
  In the present study, the JOA score and the mJOA score showed good correlation with each other in terms of their total scores and recovery rates. Previous studies using the JOA can be interpreted based on the mJOA; however it is not ideal to use them interchangeably. The validity of both scores was demonstrated by comparing these values to the PRO values.
authors.affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.affiliation: Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Takeshita
authors.affiliation: Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Miyoshi
authors.affiliation: Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kawamura
authors.affiliation: Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masuda
authors.affiliation: Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kunogi
authors.affiliation: Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Saitama, Japan.
authors.forename: Rentaro
authors.initials: R
authors.lastname: Okazaki
authors.affiliation: Department of Orthopaedic Surgery, Saitama Red Cross Hospital, Saitama, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Azuma
authors.affiliation: Department of Orthopaedic Surgery, Musashino Red Cross Hospital, Musashino, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
references.citation: Eur Spine J. 2015 Apr;24 Suppl 2:209-28
references.pmid: 24005994
references.citation: Spine (Phila Pa 1976). 2015 Jan 1;40(1):E23-8
references.pmid: 25341993
references.citation: J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12):1524-9
references.pmid: 14627890
references.citation: Spine (Phila Pa 1976). 2004 Jun 1;29(11):1271-80
references.pmid: 15167668
references.citation: Brain. 1972;95(1):87-100
references.pmid: 5023093
references.citation: Spine (Phila Pa 1976). 1981 Jul-Aug;6(4):354-64
references.pmid: 6792717
references.citation: J Neurosurg. 1985 Oct;63(4):492-9
references.pmid: 4032012
references.citation: Lancet. 1986 Feb 8;1(8476):307-10
references.pmid: 2868172
references.citation: J Manipulative Physiol Ther. 1991 Sep;14(7):409-15
references.pmid: 1834753
references.citation: J Spinal Disord. 1991 Sep;4(3):286-95
references.pmid: 1802159
references.citation: Am J Phys Med Rehabil. 1993 Oct;72(5):266-71
references.pmid: 8398016
references.citation: Schweiz Med Wochenschr. 1993 Sep 11;123(36):1682-91
references.pmid: 8211019
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: Neurosurgery. 1999 Apr;44(4):762-9; discussion 769-70
references.pmid: 10201301
references.citation: J Outcome Meas. 2001-2002;5(1):798-818
references.pmid: 16320550
references.citation: J Orthop Sci. 2007 May;12(3):227-40
references.pmid: 17530374
references.citation: Eur Spine J. 2007 Dec;16(12):2096-103
references.pmid: 17922150
references.citation: J Pers Soc Psychol. 2008 Nov;95(5):1005-18
references.pmid: 18954190
references.citation: J Cataract Refract Surg. 2015 Feb;41(2):286-94
references.pmid: 25537685
references.citation: Spine (Phila Pa 1976). 2001 Sep 1;26(17):1890-4; discussion 1895
references.pmid: 11568701
references.citation: Neurosurgery. 2010 May;66(5):1013-6
references.pmid: 20404709
references.citation: J Neurosurg Spine. 2011 Mar;14(3):348-55
references.pmid: 21235299
references.citation: J Hand Surg Am. 2011 Sep;36(9):1497-503
references.pmid: 21783329
references.citation: Eur Spine J. 2011 Sep;20(9):1545-51
references.pmid: 21424591
references.citation: J Rheumatol. 2013 Apr;40(4):379-85
references.pmid: 23457377
references.citation: J Bone Joint Surg Am. 2013 Sep 18;95(18):1651-8
references.pmid: 24048552
references.citation: Clin Rheumatol. 2014 Jun;33(6):783-9
references.pmid: 24562719
references.citation: J Crit Care. 2014 Oct;29(5):828-34
references.pmid: 24857639