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An outcome measure of functionality and pain in patients with lumbar disc herniation: a validation study of the Japanese Orthopedic Association (JOA) score

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Journal of Orthopaedic Science



Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. The Japanese Orthopedic Association (JOA) score is a very short instrument for measuring functionality and pain in these patients. This study aimed to translate and validate the JOA score for use in Iran.


This was a prospective clinical validation study. Translation of the English version of the questionnaire was performed in accordance with published guidelines. A sample of patients with LDH was asked to respond to the questionnaire at two points in time—at preoperative and postoperative (6 months follow-up) assessments. To test reliability, the internal consistency was assessed by use of Cronbach’s alpha coefficient. Validity was evaluated by use of known-groups comparison.


A total of 117 patients with LDH were entered into the study. The mean age of patients was 45 (SD = 11) and Cronbach’s alpha coefficients for the JOA score at the preoperative and postoperative assessments were 0.67 and 0.81, respectively. Validity as performed by known-groups analysis also showed the result was satisfactory. The instrument discriminated well between sub-groups of patients who differed in age and in a standard predictive measure of lumbar disc surgery (the Finneson–Cooper score).


In general, the Iranian version of the JOA score performed well and the findings suggest that it is a reliable and valid measure of functionality and pain among LDH patients.

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The authors thank the staff of the Neurosurgery Unit at Imam-Hossain Hospital, Tehran, Iran.

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The authors declare that they have no competing interests.

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Correspondence to Parisa Azimi or Ali Montazeri.

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Azimi, P., Mohammadi, H.R. & Montazeri, A. An outcome measure of functionality and pain in patients with lumbar disc herniation: a validation study of the Japanese Orthopedic Association (JOA) score. J Orthop Sci 17, 341–345 (2012).

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