Psychometric Validation of the Adapted Traditional Chinese (Hong Kong) Version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ)

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Study Design.

A prospective questionnaire translation and validation.


The aim of this study was to translate and cross-culturally adapt the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) into Traditional Chinese (Hong Kong) and to assess its validity, reliability, and sensitivity for differentiating cervical myelopathy (CM) and presence of acute neck/shoulder pain.

Summary of Background Data.

CM frequently presents with various symptoms affecting patients’ quality of life. Hence, a patient-oriented instrument such as JOACMEQ is necessary to assess patient-perceived outcomes of CM treatment.


The English version of JOACMEQ was translated and adapted using double forward and single backward translations. The translated JOACMEQ was administered to patients with suspected CM, followed by the Traditional Chinese (Hong Kong) version of the Neck Disability Index (NDI), EuroQol five-dimension five-level (EQ-5D-5L), and Short Form-12 version 2 (SF-12v2) questionnaires. Construct validity of the domains was assessed using Spearman correlation test against domains with similar constructs. Internal consistency was assessed by Cronbach's alpha. Sensitivity of the adapted JOACMEQ was determined by known group comparisons.


A total of 100 patients were recruited. Psychometric testing of the translated JOACMEQ demonstrated an excellent overall internal consistency with Cronbach's α > 0.9, and good internal consistency of Lower Extremity Function (0.823) and Quality of Life (0.875) domains. Score of all domains of the translated JOACMEQ had significant correlations (P < 0.01–0.05) with nearly all domains of SF-12v2 and with both NDI and EQ-5D-5L scores. JOACMEQ was sensitive in detecting differences (P < 0.001) between subjects who had CM and those without, and also between those patients with/without CM experiencing current neck/shoulder pain.


Our translated JOACMEQ has satisfactory psychometric properties, including adequate clinical and construct validity, and internal consistency in patients with suspected/diagnosed CM and can differentiate between those with/without pain. It is demonstrated as a sensitive outcome measure for CM and neck/shoulder pain.


Level of Evidence: 2

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