Overview & History
The Japanese Orthopaedic Association (JOA) developed the original version of this tool in 1986 to measure and track patients with lower back pain and as those with cervical spondylotic myelopathy (CMS). In 2000, the Japanese Society for Spine Surgery and Related Research (JSSR) and the Japanese Society of Lumbar Spine Disorders, decided to revise the JOA scoring system into two (2) different questionnaires which are now known as the JOA Back Pain Evaluation Questionnaire (JOABPEQ) and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). This change was initiated to create a “self-administered, disease-specific method for measuring low back pain” and in order to track outcomes for patients with cervical spondylotic myelopathy. The revision overarching goal was to make the process more patient-oriented and user friendly.
The JOABPEQ includes twenty-five (25) questions that are subdivided into five (5) subscales: lower back pain, lumbar function, walking ability, social life function and mental health. These questions are Intended to evaluate individuals with low back pain from five (5) different perspectives.
The JOACMEQ contains twenty-four (24) questions subdivided into five (5) subscales: lower extremity function, quality of life, cervical spine function, bladder function and upper extremity function. These questions are intended to evaluate individuals health-related quality of life for those who suffer from cervical spondylotic myelopathy.
How it is scored
The JOABPEQ and JOACMEQ scores range from 0 to 100, with higher scores indicating a better patient condition. A free excel file is provided on the JOA website to automatically calculate the difference in the functional scores between two (2) intervals. To determine whether a treatment has been effective, compare patients before and after assessment; if a patient’s score has increased ≥ 20, or if the overall score is >90, this indicates improvement.
The JOABPEQ and JOACMEQ are much more reliable scoring systems now that they have been revised. The overarching goal of the revision was to make the assessment more patient oriented and conducted in a way that is through the patients view rather than the physicians. Another strength is that entities do not need a license to use this tool and can download it for free. The JOA website offers other valuable tools for free, such as the excel file that calculates scores.
The questionnaires were translated from Japanese into Engish by a professor and as a result some of the wording is awkward. For example, some questions include double negatives which may be confusing for the reader however the professor wanted to ensure the meaning of the question did not change. It may be imperative to revise these questions to make it more easily understood. The same goes for the Japanese wording of the questions. However, they have been validated through statistical analysis and may not be reliable if revised.
There is controversy regarding the strength of the quality of life (QOL) subscale JOA – “The effectiveness rate of the JOACMEQ for measuring quality of life was quite low” (Asian Spine Journal, 2015). In the JOABPEQ, it may also not be as reliable of a measure for function and QOL as there is insufficient psychometric analysis to confirm the validity (Journal of Orthopaedic Science, 2007).“
Physicians have a hard time being exactly certain of the current state of the patient due to lack of reference values (Journal of Orthopaedic Science, 2015). “Despite all these prior assessments, no researcher had measured time-dependent postoperative changes affecting quality of life for patients with CSM” (Asian Spine Journal, 2015).”
The JOACMEQ and JOABPEQ do not require a license and may be downloaded for free on the
Asian Spine Journal. (February 9, 2015).Comparison of the Japanese Orthopaedic Association Score and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Scores: Time-Dependent Changes in Patients with Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament. PMC.
Journal of Orthopaedic Science. (February, 2015). Japanese orthopaedic association back pain evaluation questionnaire (JOABPEQ) as an outcome measure for patients with low back pain: reference values in healthy volunteers.
The Japanese Orthopaedic Association. (April 16, 2007). JOA back pain evaluation questionnaire (JOABPEQ)/JOA cervical myelopathy evaluation questionnaire (JOACMEQ) The report on the development of revised versions.