Validity of the Japanese core outcome measures index (COMI)-neck for cervical spine surgery: a prospective cohort study



To investigate the psychometric properties of the Japanese version of the Core Outcome Measures Index-Neck (COMI-Neck) in patients undergoing cervical spine surgery.


A total of 177 patients undergoing cervical spine surgery for spinal disorders from April to December 2017 were enrolled. Patient-reported outcomes (PROs) included EuroQOL, Neck Disability Index, and treatment satisfaction. To address whether the questionnaire’s scores relate to other outcomes based on a predefined hypothesis, the correlations between the COMI-Neck and the other PROs were measured (Spearman’s rank correlation coefficients). The minimum clinically important difference (MCID) of the COMI summary score was calculated using the receiver operating characteristic (ROC) curve with a 7-point Likert scale of satisfaction with the treatment results. To assess reproducibility, another group of 59 volunteers with chronic neck pain were asked to reply to the COMI-Neck twice with an interval of 7–14 days.


The COMI summary score showed no floor or ceiling effects preoperatively or postoperatively. Each of the COMI domains and the COMI summary score correlated to the hypothesized extent with the scores of the reference questionnaires (ρ = 0.40–0.79). According to the ROC curve with satisfaction (including “very satisfied” and “satisfied”), the area under the curve and MCID of the COMI summary score were 0.78 and 2.1. The intraclass correlation coefficient and the minimum detectable change (MDC 95%) of the COMI summary score were 0.97 and 0.77.


The Japanese version of the COMI-Neck is valid and reliable for Japanese-speaking patients with cervical spinal disorders.

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  1. 1.

    Badhiwala JH, Ahuja CS, Akbar MA, Witiw CD, Nassiri F, Furlan JC, Curt A, Wilson JR, Fehlings MG (2020) Degenerative cervical myelopathy—update and future directions. Nat Rev Neurol 16:108–124.

    Article  PubMed  Google Scholar 

  2. 2.

    Oshima Y, Seichi A, Takeshita K, Chikuda H, Ono T, Baba S, Morii J, Oka H, Kawaguchi H, Nakamura K, Tanaka S (2012) Natural course and prognostic factors in patients with mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging. Spine (Phila Pa 1976) 37:1909–1913.

    Article  Google Scholar 

  3. 3.

    Rhee J, Tetreault LA, Chapman JR, Wilson JR, Smith JS, Martin AR, Dettori JR, Fehlings MG (2017) Nonoperative versus operative management for the treatment degenerative cervical myelopathy: an updated systematic review. Global Spine J 7:35S-41S.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Kato S, Nouri A, Wu D, Nori S, Tetreault L, Fehlings MG (2017) Comparison of anterior and posterior surgery for degenerative cervical myelopathy: an mri-based propensity-score-matched analysis using data from the prospective multicenter aospine csm North America and international studies. J Bone Joint Surg Am 99:1013–1021.

    Article  PubMed  Google Scholar 

  5. 5.

    Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K (2001) Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976) 26:1890–1894. (discussion 1895)

    CAS  Article  Google Scholar 

  6. 6.

    Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:286–295.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Vernon H, Mior S (1991) The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 14:409–415

    CAS  PubMed  Google Scholar 

  9. 9.

    EuroQol G (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208.

    Article  Google Scholar 

  10. 10.

    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  11. 11.

    Kato S, Oshima Y, Matsubayashi Y, Taniguchi Y, Tanaka S, Takeshita K (2019) Minimum Clinically Important Difference and Patient Acceptable Symptom State of Japanese Orthopaedic Association Score in Degenerative Cervical Myelopathy Patients. Spine (Phila Pa 1976) 44:691–697.

    Article  Google Scholar 

  12. 12.

    Ohya J, Oshima Y, Takeshita K, Oka H, Chikuda H, Taniguchi Y, Matsubayashi Y, Tanaka S (2015) Patient satisfaction with double-door laminoplasty for cervical compression myelopathy. J Orthop Sci 20:64–70.

    Article  PubMed  Google Scholar 

  13. 13.

    Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23:2003–2013.

    CAS  Article  Google Scholar 

  14. 14.

    Kim SJ, Basur MS, Park CK, Chong S, Kang YG, Kim MJ, Jeong JS, Kim TK (2017) Crosscultural adaptation and validation of the Korean version of the new knee society knee scoring system. Clin Orthop Relat Res 475:1629–1639.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026.

    Article  PubMed  Google Scholar 

  16. 16.

    Ferrer M, Pellise F, Escudero O, Alvarez L, Pont A, Alonso J, Deyo R (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine (Phila Pa 1976) 31:1372–1379. (discussion 1380)

    Article  Google Scholar 

  17. 17.

    Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009a) The quality of spine surgery from the patient’s perspective. Part 1: the Core Outcome Measures Index in clinical practice. Eur Spine J 18(3):367–373.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009b) The quality of spine surgery from the patient’s perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(3):374–379.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Fankhauser CD, Mutter U, Aghayev E, Mannion AF (2012) Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck. Eur Spine J 21:101–114.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Monticone M, Ferrante S, Maggioni S, Grenat G, Checchia GA, Testa M, Teli MG, Mannion AF (2014) Reliability, validity and responsiveness of the cross-culturally adapted Italian version of the Core Outcome Measures Index (COMI) for the neck. Eur Spine J 23:863–872.

    Article  PubMed  Google Scholar 

  21. 21.

    Miekisiak G, Banach M, Kiwic G, Kubaszewski L, Kaczmarczyk J, Sulewski A, Kloc W, Libionka W, Latka D, Kollataj M, Zaluski R (2014) Reliability and validity of the polish version of the Core Outcome Measures Index for the neck. Eur Spine J 23:898–903.

    Article  PubMed  Google Scholar 

  22. 22.

    Karabicak GO, Hazar Kanik Z, Gunaydin G, Pala OO, Citaker S (2020) Reliability and validity of the Turkish version of the Core Outcome Measures Index for the neck pain. Eur Spine J 29:186–193.

    Article  PubMed  Google Scholar 

  23. 23.

    Yoshimoto T, Matsudaira K, Kawaguchi M, Haga Y, Inuduka K, Fujii T, Nagata K, Nakamoto H, Oka H, Oshima Y (2018) Development of a Japanese version of the Core Outcome Measures Index; translation and linguistic validation. Seikeigeka 69:1293–1300 ((in Japanese))

    Google Scholar 

  24. 24.

    Nagata K, Oshima Y, Nakamoto H, Sakamoto R, Ohtomo N, Izuka M, Nakajima K, Yoshimoto T, Fujii T, Matsudaira K, Tanaka S, Oka H (2019) Validity of the Japanese Core Outcome Measures Index (COMI)-back for thoracic and lumbar spine surgery: a prospective cohort study. Eur Spine J.

    Article  PubMed  Google Scholar 

  25. 25.

    McHorney CA, Tarlov AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4:293–307.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42.

    Article  Google Scholar 

  27. 27.

    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Devji T, Carrasco-Labra A, Qasim A, Phillips M, Johnston BC, Devasenapathy N, Zeraatkar D, Bhatt M, Jin X, Brignardello-Petersen R, Urquhart O, Foroutan F, Schandelmaier S, Pardo-Hernandez H, Vernooij RW, Huang H, Rizwan Y, Siemieniuk R, Lytvyn L, Patrick DL, Ebrahim S, Furukawa T, Nesrallah G, Schunemann HJ, Bhandari M, Thabane L, Guyatt GH (2020) Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study. BMJ 369:m1714.

    Article  PubMed  PubMed Central  Google Scholar 

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The authors thank all the following spine surgeons who participated in data collection. H. Hasebe, S. Hirai, N Tachibana, Y Sato, S Kato, T Doi, Y Matsubayashi, and Y Taniguchi.


No funds were received in support of this work.

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Correspondence to Yasushi Oshima.

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Oshima, Y., Nagata, K., Nakamoto, H. et al. Validity of the Japanese core outcome measures index (COMI)-neck for cervical spine surgery: a prospective cohort study. Eur Spine J 30, 402–409 (2021).

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  • COMI
  • Cervical spine
  • Patient-reported outcome
  • Neck pain
  • Cervical myelopathy