COSMIN database

A summary of assessment tools for patients suffering from cervical spondylotic myelopathy: a systematic review on validity, reliability and responsiveness

Singh, A., Tetreault, L., Casey, A., Laing, R., Statham, P., and Fehlings, M. G.
PURPOSE: One of the objectives of this review is to summarize the important features of a good scale. A second aim is to conduct a systematic review to identify scales that can detect the presence of cervical myelopathy and to determine their psychometric properties including validity, reliability and responsiveness.

METHODS: A thorough literature search was performed using MEDLINE, MEDLINE in process, EMBASE, and Cochrane Central Register of Controlled Trials. Articles were included in this study if they compared scale measurements between a control and a myelopathic patient population or if they discussed any psychometric property of a scale.

RESULTS: An ideal scale should be one that is quantifiable, valid, sensitive, responsive and easy to perform, has high inter/intra-rater reliability, internal consistency and a suitable distribution, and is one-dimensional and relevant. In the context of cervical spondylotic myelopathy, it is essential that the scale also addresses the pathophysiology, its key signs and symptoms as well as its natural history. For the systematic review, the search yielded 5,745 citations. Of these, 37 met inclusion criteria, 10 explored the ability of a scale to detect myelopathy, 23 examined validity by assessing correlation between scales, 10 reported reliability, 8 analyzed responsiveness, and 6 discussed internal consistency. The most frequently reported scale was short form-36 (n = 16) followed by Nurick grade (n = 14), Japanese Orthopaedic Association (n = 13), (modified) Japanese Orthopaedic Association (n = 7) and grip and release test (n = 6). Four studies each presented results on the Cooper, Harsh and 30-m walking test.

CONCLUSION: This review summarizes outcome measures used to assess the presence and severity of cervical myelopathy. It includes several validation studies as well as those that have reported the responsiveness and reliability of various measures.
Eur Spine J
1432-0932 (Electronic)
Publication year:
Symptom status:
Physical state
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
10s step test - 10 seconds Step Test
30m walking test (steps)
BQ - Bournemouth Questionnaire
CNFDS - Copenhagen Neck Functional Disability Scale
Cooper Test
CSOQ - Cervical Spine Outcome Questionnaire
CWT - Comfortable Walk Test (versions: 3M; 4M; 5M; 6M; 7M; 8M; 10M; 12M; 30Metre)
EMS - European Myelopathy Score
Foot tapping test
Grip and release test
Harsh Scale
JOACMEQ - Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire
JOA - Myelopathy scale of the Japanese Orthopaedic Association (versions: mJOA)
knee extension
MDI - Myelopathy Disability Index
NASS - North American Spine Society Questionnaire (versions:NASS-lumbar ; NASS-cervical; NASS-AAOS)
NDI - Neck Disability Index    
NHPT - Nine-Hole Peg Test   
NRS - Numeric Rating Scale (versions: NRS-6; NRS-11; NRS-21)   
Nurick score
PSFS - Patient-Specific Functional Scale   
PS - Prolo Scale [alias: Prolo Score] [alias: Prolo Economic Functional Rating Scale]
SF-12 - 12-item Short Form Health Survey [alias: RAND-12]
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
Triangle step test
VAS - Visual Analogue Scale (versions: vertical; horizontal)   
WHOQOL-BREF - World Health Organization Quality of Life questionnaire–Abbreviated Questionnaire (versions: WHOQOL-HIV-BREF)