The list of validity, reliability, and responsiveness study frequency in a CSM population was also established. The SF-36 was evaluated the most (N = 5) followed by MDI (N = 2), whereas mJOA scale, Nurick grade, and EMS each had one study assessing psychometric characteristics in a CSM population. No validity, reliability, or responsiveness study was found for the pain VAS or NDI in the CSM population (Table 1; Figure 3).
Modified Japanese Orthopaedic Association Scale
The mJOA3 is a modified version of the original JOA scale. It is scored on a 0 to 18 point scale with the lowest score, representing greater disability (Table 1). It is a clinician-based measure that covers items such as upper and lower extremity motor function, hand sensation, and micturition. Only one study4 was identified that tested reliability of the mJOA. This study found the mJOA to have a high degree of interobserver reliability (Table 1). Thus, this tool can be reliably used among multiple examiners.
The Nurick Scale4 was developed to assess gait impairment in patients with CSM. The Nurick Scale is a clinician-based measure containing six grades of CSM ranging from 0 to 5, with a focus on gait impairment (Table 1). As the grade increases the disability increases. One study5 was identified that tested the validity, reliability, and responsiveness of the Nurick Scale. This study compared 7 different outcome measures in a CSM population. The Nurick Scale was validated against the postoperative MDI, EMS, and Ranawat Scale (Table 1).
Myelopathy Disability Index
The MDI6 was developed to measure disability objectively in rheumatoid arthritis complicated by CSM. The MDI consists of 10 items ranging from 0 to 3 points (Table 1). It is a self-report measure that covers the items sit-to-stand, eating, walking, hygiene, and grip strength. These 10 items are summed and converted to percentage with a maximum score of 100 and minimum score of 0.5,6 Disability increases as the score increases. Two studies were identified that tested its validity, reliability, and responsiveness. In one study the MDI was validated against the 20-item Health Activity Questionnaire, Ranawat class, and Steinbrocker grade (Table 1).6 In another study, the MDI was validated against the EMS.5 The MDI was found to be reliable and responsive in both studies (Table 1).5,6 Despite the rigor of this measure's development, it is one of the least used outcomes.
Neck Disability Index
The NDI7 is a modification of the Oswestry Disability Index and developed as a self-report measure of neck pain. The NDI consists of 10 items ranging from 0 to 5 points (Table 1). Some items that the NDI measures are lifting, pain, driving, sleeping, and work activities. These 10 items are summed and normalized to 100. Maximum score is 100 and minimum score is 0. An increasing score indicates increasing disability. The NDI has not had validity or reliability testing in a CSM population but has in patients who underwent neck surgery.
European Myelopathy Scale
The EMS8 was developed to assess myelopathy. It consists of the following 5 items: gait, hand function, proprioception, bladder and bowel function, and parasthesias. Items are scored from 1 to a variable maximum of 3, 4, or 5. Items are summed with a maximum score of 18 and a minimum score of 5 points. An increasing score indicates an increase in severity of myelopathy. One study has addressed validity, reliability, and responsiveness. The EMS was validated against the MDI and, in the same study, was found to have poor sensitivity to change.5
Short-Form 36 Health Survey
The Short-Form 36 Health Survey9 is a measure of patient health status. The SF-36 consists of 8 subscales: Vitality, Physical Functioning, Bodily Pain, General Health, Physical Role, Emotional Role, Social Role, and Mental Health. Items of each subscale are averaged to yield a score of 0 to 100. A score closer to zero represents greater disability. The SF-36 has been tested for validity, reliability, and responsiveness in the CSM population. Guilfoyle et al validated the SF-36 against the MDI and Roland-Morris scale.9 King and Roberts validated the SF-36 against the Nurick Scale, Cooper Scale, and Harsh Scale10; Latimer et al compared the SF-36 with the NDI, MDI, and VAS for neck and arm pain.11 King and Roberts10 found the SF-36 to be reliable. The SF-36 was found to be responsive in 3 studies.11–13
Visual Analogue Scale (VAS) for Pain
The visual analogue scale (VAS) for pain is a single item asking respondents to rate their pain level on a continuous line between 2 end points. On a horizontal line, the further to the left the mark the greater the pain. On a vertical line, the higher the mark the greater the pain. No studies exist testing validity, reliability, or responsiveness of the VAS in the CSM population.
Stage 2—Defining a Framework and Setting Selection Criteria for the Second Search: What Are the Requirements of Outcome Measures Specific to CSM?
The initial literature search does identify measures specific to CSM, which have some psychometric development. However, none of these measures objectively quantify physical findings of the individual. Despite frequency of use, there continues to be a gap due to the insensitivity of the available outcome measures. Therefore, it is necessary to identify ancillary measures that can be used to measure this population in detail a we continue to learn about this disease from the basic and clinical perspectives. Measurement in this field has lagged and will become a concept of significant interest as we learn more about the pathophysiology of this disease, and as new discoveries are translated to humans.2 Selection criteria for outcome measures are defined in the Methods. The criteria were used to identify six outcome measures, QuickDASH, Berg Balance Scale, 30-Meter Walk Test (30MWT), a modified Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Grip strength (dynamometer), and GAITRite.
Stage 3—Targeted Literature Search on Specified Outcome Measures Selected on the Basis of Criteria in Stage 2: What Are the Most Reliable, Valid, Responsive, and Quantitative Outcome Measures That Can Be Used for CSM?
A number of measures do exist, which are appropriate to administer in the CSM population despite their development and use in different but similar patient groups. These ancillary measures can provide information that is more sensitive and developed in a more rigorous fashion than existing tools. These measures are described in Table 2, and how to consider their use is described in Table 3.
The QuickDASH14 was developed to measure physical function and symptoms related to upper limb musculoskeletal disorders by creating a shorter version of the Disabilities of the Arm Shoulder and Hand questionnaire (DASH; see Hudak et al15) (see erratum). The QuickDASH consists of 3 modules (2 modules are optional). The disability and symptom module consists of 11 items ranging from 1 to 5 points (Table 1). It is a self-report measure that covers activities of daily living, recreation activities, social activities, work activities, arm/hand sensation and pain, and sleeping. Items are summed and then normalized from 0 to 100. The higher the score, the greater the disability. For this metric, no validity, reliability, or responsiveness studies were identified in a CSM population. Other populations in which validity, reliability, or responsiveness have been tested include: upper extremity musculoskeletal disorders,14,16–26 carpal tunnel syndrome,27 neck pain,18,19,28,29 upper limb burn,30 and Duypuytren disease.31
Berg Balance Scale
The Berg Balance Scale32 was developed to measure balance among elderly people with impairment. The Berg Balance Scale consists of 14 items scored from 0 to 4 points (Table 1). It is a performance measure that evaluates unsupported standing balance, unsupported sitting balance, and transfers. Maximum score is 56 and minimum score is 0. A lower score represents greater disability. No validity, reliability, or responsiveness studies were identified in a CSM population. Other populations in which validity, reliability, or responsiveness have been tested include: stroke,33–42 balance disorder,43,44 elderly,45–49 multiple sclerosis,41–53 and Parkinson disease,54–56 Neurological disorders including spinal cord and brain injury,57–59 cognitive disability,60,61 and knee arthroplasty.62
Walk Test—30-Meter Walk Test
Several walking tests were identified, including the 30MWT, 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT). The 30MWT63 seems to be the most common and was developed to measure disability of patients with CSM. The 30MWT is a performance measure of time in seconds to walk 30 m (Table 1). The greater the time, the greater the disability. One study63 was identified that tested its validity and reliability, and no studies were identified that tested responsiveness. The 30MWT was validated against the MDI and Nurick Scale and was highly reproducible. The 30MWT has also been tested in a chronic obstructive pulmonary disease population.64
Graded Redefined Assessment of Strength Sensibility and Prehension
The GRASSP65 was developed as a clinical outcome measure specific to upper limb impairment in individuals with complete or incomplete traumatic tetraplegia. It comprises 5 subtests for each upper limb: dorsal sensation, palmar sensation, strength, and prehension. There are 5 numerical scores that provide a comprehensive profile of upper limb function. No validity, reliability, or responsiveness studies were found in a CSM population in the literature. However, the GRASSP has been validated in the chronic traumatic SCI population.65–67
Grip dynamometer is an instrument used for measuring the force of handgrip muscular contraction. Currently no validity, reliability, or responsiveness studies were found in a CSM population. It has been tested in healthy volunteer individuals.69,74–76
GAITRite Analysis71 is a computerized walkway system embedded with pressure sensors that detect a series of footfalls. The walkway is connected to a personal computer with application software that calculates temporal and spatial gait parameters. No studies were identified in a CSM population testing validity, reliability, or responsiveness. However, the GAITRite system has been tested in these populations: elderly,71–74 children with motor disabilities,73 knee replacement,74 and patients with Parkinson disease.77
As the literature and practice regarding the management of CSM evolves, a remaining challenge is the lack of validation of the outcome measures that are being used to evaluate and define the population. The literature establishes that there is a paucity of measures available, particularly specific, quantitative, sensitive, and validated measures. There are 2 main factors that limit individuals with CSM, upper limb function, and gait impairment (which is closely related to balance). Urogenital dysfunction is also a consequence of cervical cord compression. Consideration of all aspects of impairment and their impact on function are very important. Furthermore, because the variability of impairment is so large, using more than one outcome assists in characterization of the individual, which will enlighten the clinician. Ultimately the selected outcomes will establish more detail at baseline, allow for outcome assessment and assist in decision making pretreatment to determine if there is progression of disease.
The 2 most commonly used measures to quantify CSM are the JOA scale78 and the Nurick grade.4 Both are measures of signs and symptoms, which evaluate gait, lower extremity function, hand function, and bladder control. Despite the widespread use of these outcome measures, they lack the sensitivity to assess the full range of CSM, especially patients with a mild presentation. However, the mJOA is the only measure that addresses the bladder dysfunction in this disease. Commonly used self-perceived measures of improvement in CSM are the NDI79 and the general outcome, SF-36.80 These measures have both been validated for use in patients with cervical spine disorders and provide adequate information regarding self-perceived function.79,80 Neither the JOA nor Nurick assess in a quantitative manner gait, balance, or hand function as it may relate to one's ability to function on a daily basis. Thus, a method using ancillary measures to define severity is required to define clinical presentation in a standardized manner. Measures with greater responsiveness are necessary to define the milder subpopulation and define the predictors of progression, particularly for those individuals who are not offered surgery early in the course of CSM. Use of ancillary measures will also provide the pertinent information required to establish predictors of recovery and outcome after intervention.
To date, the most common methods for treating CSM are by conservative management or performing decompressive surgery. Surgery is more commonly offered to those with a moderate to severe presentation of CSM; however, there is an increase in the number of individuals with mild CSM having surgery. Surgical techniques and approaches have evolved during the past 2 decades, as a result, outcomes are much improved.81,82 Despite the advances in surgical management, the void that remains in the clinical field is the lack of outcome measures which can characterize the population with greater precision. More sensitive outcomes will be useful in establishing efficacy of interventions; assist in identifying the predictors of disease progression and enable clinicians to offer treatment that is most effective and offered at the most appropriate time in the course of this disease. Essentially this will lead to the treatment of CSM before the irreversible sequelae are manifested. Understanding the deficits of this population will enable the establishment of a standard method to define a severity of disease index. Therefore, the objective of this review was to identify the most clinically relevant, quantitative, reliable, valid, and responsive outcome measures for the assessment of CSM that will establish a meaningful clinical dataset, which will allow clinicians to assess outcomes, monitor the natural history of CSM, and establish the predictive value of clinical findings.
Clinicians should consider use of the ancillary measures: QuickDASH, Berg Balance Scale, GRASSP Version 1.0, Grip Strength, GAITRite Analysis, and the 30MWT.
These measures should be implemented into clinical practice either for screening, longitudinal clinical assessment, or longitudinal research assessment. A clinician should consider the use of the outcome measure prior to selection and whether the role of the measure is for screening, longitudinal follow-up, or research follow-up. Use of measures will vary depending on the practice one conducts. However, the NDI and mJOA should always be administered when a patient presents with CSM. These should be standard measures used across centers (see Supplemental Digital Content Appendix 1, available at http://links.lww.com/BRS/A822).
The goal of this review was to identify the most reliable, valid, responsive, and quantitative, outcome measures for the assessment of CSM that will establish a meaningful clinical dataset to allow clinicians to assess outcomes, monitor the natural history of CSM, and establish the prognostic value of clinical findings. The CSM population is a heterogeneous population that cannot be defined thoroughly with a single score on a single outcome measure. Because the clinical presentation and manifestation of CSM is not unidimensional, it is not feasible to use a single unidimensional outcome without missing a large aspect of meaningful clinical information. On the basis of the measures that are available specifically for CSM and related populations, we have established a framework for the use of outcome measures. In summary, we recommend that the mJOA, Nurick grade, MDI, NDI, and 30MWT are most appropriate for the assessment of CSM. However, 6 additional outcome measures (QuickDASH, Berg Balance Scale, GRASSP, Grip Dynamometer, GAITRite Anlaysis) were identified, which provide complementary assessments for CSM.
Summary Statements. There does not exist a single or composite of outcomes instruments that measures myelopathy impairment, function/disability, and participation that has also demonstrated reliability, validity, and responsiveness in a CSM population. More work in the development and psychometric evaluation of new or existing measures is necessary to identify the ideal composite of measures to be used in the clinical and research settings.
- The mJOA, Nurick grade, NDI, MDI, and 30MWT should be adopted in any clinical practice that treats CSM both for screening and clinical follow-up.
- We propose that clinicians and researchers consider using the ancillary measures identified, such as the QuickDASH, Berg Balance Scale, GRASSP version 1.0, Grip Strength, and GAITRite Analysis.
- It is highly recommended that baseline and follow-up measurements should be performed in patients with CSM.
- Although a single outcome measure cannot define the broad range of deficits seen in the CSM population, we recommend the use of the mJOA, NDI, Nurick Scale, and the 30MWT.
- Use of reliable, valid, and responsive outcome measures in CSM is necessary to establish improved management of the population.
- Measures that specifically and sensitively quantify gait, balance, hand strength, hand function, and self-perceived function related to tetraparesis provide more refined information regarding this population.
- Use of such measures will improve clinical management, monitoring, and prognosis for patients with CSM.
Supplemental digital content is available for this article. Direct URL citation appearing in the printed text is provided in the HTML and PDF version of this article on the journal's web site (www.spinejournal.com).
1. Young WF. Cervical spondylotic myelopathy
: a common cause of spinal cord dysfunction in older persons. Am Fam Phys 2000;62:1064–70, 1073.
2. Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy
: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. [published online ahead of print November 30, 2012] Neuroscientist 2013;19:409–21.
3. Benzel EC, Lancon J, Kesterson L, et al. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy
. J Spinal Disord 1991;4:286–95.
4. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95:87–100.
5. Singh A, Crockard HA. Comparison of seven different scales used to quantify severity of cervical spondylotic myelopathy
and post-operative improvement. J Outcome Meas 2001;5:798–818.
6. Casey AT, Bland JM, Crockard HA. Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy. Ann Rheum Dis 1996;55:901–6.
7. Bartels RH, Verbeek AL, Benzel EC, et al. Validation of a translated version of the modified Japanese Orthopaedic Association score to assess outcomes in cervical spondylotic myelopathy
: an approach to globalize outcomes assessment tools. Neurosurgery 2010;66:1013–6.
8. Herdman J, Linzbach M, Krzan M eds. The European Myelopathy Score. Berlin: Springer Verlag; 1994.
9. Guilfoyle MR, Seeley H, Laing RJ. The Short Form 36 health survey in spine disease–validation against condition-specific measures. Br J Neurosurg 2009;23:401–5.
10. King JT Jr, Roberts MS. Validity and reliability of the Short Form-36 in cervical spondylotic myelopathy
. J Neurosurg 2002;97:180–5.
11. Latimer M, Haden N, Seeley HM, et al. Measurement of outcome in patients with cervical spondylotic myelopathy
treated surgically. Br J Neurosurg 2002;16:545–9.
12. Singh A, Gnanalingham K, Casey A, et al. Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy
: comparison with SF-36. Spine 2006;31:639–43.
14. Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87:1038–46.
15. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–8. [Erratum in: Am J Ind Med
1996 Sep;30(3):372. PubMed PMID: 8773720.]
16. Angst F, Goldhahn J, Drerup S, et al. How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function
and specific joint conditions. Qual Life Res 2009;18:1043–51.
17. Dale LM, Strain-Riggs SR. Comparing responsiveness of the Quick Disabilities of the Arm, Shoulder, and Hand and the Upper Limb Functional Index. Work 2012;13:13.
18. Fan ZJ, Smith CK, Silverstein BA. Assessing validity of the QuickDASH and SF-12 as surveillance tools among workers with neck or upper extremity musculoskeletal disorders. J Hand Ther 2008;21:354–65.
19. Fan ZJ, Smith CK, Silverstein BA. Responsiveness of the QuickDASH and SF-12 in workers with neck or upper extremity musculoskeletal disorders: one-year follow-up. J Occup Rehabil 2011;21:234–43.
20. Franchignoni F, Ferriero G, Giordano A, et al. Psychometric properties of QuickDASH - a classical test theory and Rasch analysis study. Man Ther 2011;16:177–82.
21. Gabel CP, Yelland M, Melloh M, et al. A modified QuickDASH-9 provides a valid outcome instrument for upper limb function
. BMC Musculoskelet Disord 2009;10:1471–2474.
22. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006;7:44.
23. Hoang-Kim A, Pegreffi F, Moroni A, et al. Measuring wrist and hand function
: common scales and checklists. Injury 2011;42:253–8.
24. Mintken PE, Glynn P, Cleland JA. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J Shoulder Elbow Surg 2009;18:920–6.
25. Polson K, Reid D, McNair PJ, et al. Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther 2010;15:404–7.
26. Stover B, Silverstein B, Wickizer T, et al. Accuracy of a disability instrument to identify workers likely to develop upper extremity musculoskeletal disorders. J Occup Rehabil 2007;17:227–45.
27. Lyren PE, Atroshi I. Using item response theory improved responsiveness of patient-reported outcomes measures in carpal tunnel syndrome. J Clin Epidemiol 2012;65:325–34.
28. Mehta S, Macdermid JC, Carlesso LC, et al. Concurrent validation of the DASH and the QuickDASH in comparison to neck-specific scales in patients with neck pain. Spine 1976;35:2150–6.
29. Melloh M, Gabel CP, Cuesta-Vargas AI. Factor analysis findings for the QuickDASH. Re: Mehta S, MacDermid JC, Carlesso LC, et al. Concurrent validation of the DASH and the QuickDASH in comparison to neck-specific scales in patients with neck pain. Spine 2010;35:2150–56. Spine (Phila Pa 1976)
2011; author reply 1260–1. doi:10.1097/BRS.0b013e31821bbd7c.
30. Wu A, Edgar DW, Wood FM. The QuickDASH is an appropriate tool for measuring the quality of recovery after upper limb burn injury. Burns 2007;33:843–9.
31. Budd HR, Larson D, Chojnowski A, et al. The QuickDASH score: a patient-reported outcome measure for Dupuytren's surgery. J Hand Ther 2011; quiz 21. doi:10.1016/j.jht.2010.08.006.
32. Berg EM, Wood-Dauphinee S, Kesterson L, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989;41:304–11.
33. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008;88:559–66.
34. Flansbjer UB, Blom J, Brogardh C. The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests. Pm R 2012;4:165–70.
35. Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch Phys Med Rehabil 2012;93:1201–8.
36. Liaw LJ, Hsieh CL, Hsu MJ, et al. Test-retest reproducibility of two short-form balance measures used in individuals with stroke. Int J Rehabil Res 2012;35:256–62.
37. Liaw LJ, Hsieh CL, Lo SK, et al. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil 2008;30:656–61.
38. Mao HF, Hsueh IP, Tang PF, et al. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke 2002;33:1022–7.
39. Salbach NM, Mayo NE, Higgins J, et al. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil 2001;82:1204–12.
40. Tyson SF, DeSouza LH. Reliability and validity of functional balance tests post stroke. Clin Rehabil 2004;18:916–23.
41. Wee JY, Wong H, Palepu A. Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation. Arch Phys Med Rehabil 2003;84:731–5.
42. Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 2001;47:29–38.
43. Godi M, Franchignoni F, Caligari M, et al. Comparison of reliability, validity, and responsiveness of the Mini-Bestest and berg balance scale in patients with balance disorders. Phys Ther 2013;93:158–67.
44. Whitney S, Wrisley D, Furman J. Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Physiother Res Int 2003;8:178–86.
45. Conradsson M, Lundin-Olsson L, Lindelof N, et al. Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther 2007;87:1155–63.
46. Holbein-Jenny MA, Billek-Sawhney B, Beckman E, et al. Balance in personal care home residents: a comparison of the Berg Balance Scale, the Multi-Directional Reach Test, and the Activities-Specific Balance Confidence Scale. J Geriatr Phys Ther 2005;28:48–53.
47. Muir SW, Berg K, Chesworth B, et al. Use of the Berg Balance Scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther 2008;88:449–59.
48. Pardasaney PK, Latham NK, Jette AM, et al. Sensitivity to change and responsiveness of four balance measures for community-dwelling older adults. Phys Ther 2012;92:388–97.
49. Wang CY, Hsieh CL, Olson SL, et al. Psychometric properties of the Berg Balance Scale in a community-dwelling elderly resident population in Taiwan. J Formos Med Assoc 2006;105:992–1000.
50. Cattaneo D, Jonsdottir J, Repetti S. Reliability of four scales on balance disorders in persons with multiple sclerosis. Disabil Rehabil 2007;29:1920–5.
51. Learmonth YC, Paul L, McFadyen AK, et al. Reliability and clinical significance of mobility and balance assessments in multiple sclerosis. Int J Rehabil Res 2012;35:69–74.
52. Paltamaa J, West H, Sarasoja T, et al. Reliability of physical functioning measures in ambulatory subjects with MS. Physiother Res Int 2005;10:93–109.
53. Cattaneo D, Regola A, Meotti M. Validity of six balance disorders scales in persons with multiple sclerosis. Disabil Rehabil 2006;28:789–95.
54. King LA, Priest KC, Salarian A, et al. Comparing the Mini-BESTest with the berg balance scale to evaluate balance disorders in parkinson's disease. Parkinsons Dis 2012;375419:24.
55. Lim LI, van Wegen EE, de Goede CJ, et al. Measuring gait and gait-related activities in Parkinson's patients own home environment: a reliability, responsiveness and feasibility study. Parkinsonism Relat Disord 2005;11:19–24.
56. Qutubuddin AA, Pegg PO, Cifu DX, et al. Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation. Arch Phys Med Rehabil 2005;86:789–92.
57. Lemay JF, Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord 2010;48:245–50.
58. Newstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg Balance Scale and balance master limits of stability tests for individuals with brain injury. J Neurol Phys Ther 2005;29:18–23.
59. Wirz M, Muller R, Bastiaenen C. Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair 2010;24:70–7.
60. Sackley C, Richardson P, McDonnell K, et al. The reliability of balance, mobility and self-care measures in a population of adults with a learning disability known to a physiotherapy service. Clin Rehabil 2005;19:216–23.
61. Waninge A, van Wijck R, Steenbergen B, et al. Feasibility and reliability of the modified Berg Balance Scale in persons with severe intellectual and visual disabilities. J Intellect Disabil Res 2011;55:292–301.
62. Jogi P, Spaulding SJ, Zecevic AA, et al. Comparison of the original and reduced versions of the Berg Balance Scale and the Western Ontario and Mcmaster Universities Osteoarthritis Index in patients following hip or knee arthroplasty. Physiother Can 2011;63:107–14.
63. Singh A, Crockard HA. Quantitative assessment of cervical spondylotic myelopathy
by a simple walking test. Lancet 1999;354:370–3.
64. Andersson M, Moberg L, Svantesson U, et al. Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test. Prim Care Respir J 2011;20:434–40.
65. Kalsi-Ryan S, Curt A, Verrier MC, et al. Development of the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia
. J Neurosurg Spine 2012;17:65–76.
66. Boakye M, Harkema S, Ellaway PH, et al. Quantitative testing in spinal cord injury: overview of reliability and predictive validity. J Neurosurg Spine 2012;17:141–50.
67. Kalsi-Ryan S, Beaton D, Curt A, et al. The Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity. J Neurotrauma 2012;29:905–14.
68. Bohannon RW. Test-retest reliability of the MicroFET 4 hand-grip dynamometer. Physiother Theory Pract 2006;22:219–21.
69. Clerke AM, Clerke JP, Adams RD. Effects of hand shape on maximal isometric grip strength and its reliability in teenagers. J Hand Ther 2005;18:19–29.
70. Hamilton GF, McDonald C, Chenier TC. Measurement of grip strength: validity and reliability of the sphygmomanometer and jamar grip dynamometer. J Orthop Sports Phys Ther 1992;16:215–19.
72. Lord S, Galna B, Verghese J, et al. Independent domains of gait in older adults and associated motor and nonmotor attributes: validation of a factor analysis approach. J Gerontol A Biol Sci Med Sci 2012;18:18.
73. McGough EL, Logsdon RG, Kelly VE, et al. Functional mobility limitations and falls in assisted living residents with dementia: physical performance assessment and quantitative gait analysis. J Geriatr Phys Ther 2012;12:12.
74. Montero-Odasso M, Casas A, Hansen KT, et al. Quantitative gait analysis under dual-task in older people with mild cognitive impairment
: a reliability study. J Neuroeng Rehabil 2009;6:1743–0003.
75. Wondra VC, Pitetti KH, Beets MW. Gait parameters in children with motor disabilities using an electronic walkway system: assessment of reliability. Pediatr Phys Ther 2007;19:326–31.
76. Webster KE, Wittwer JE, Feller JA. Validity of the GAITRite walkway system for the measurement of averaged and individual step parameters of gait. Gait Posture 2005;22:317–21.
77. Nelson AJ, Zwick D, Brody S, et al. The validity of the GaitRite and the Functional Ambulation Performance scoring system in the analysis of Parkinson gait. NeuroRehabilitation 2002;17:255–62.
78. Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981;6:354–64.
79. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–15.
80. Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–83.
81. Mummaneni PV, Kaiser MG, Matz PG, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy
. Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. J Neurosurg Spine 2009;11:130–41. doi: 10.3171/2009.3.SPINE08728.
82. Matz PG, Anderson PA, Holly LT, et al. The natural history of cervical spondylotic myelopathy
. J Neurosurg Spine 2009 11:104–11.
impairment; tetraplegia; function; cervical spondylotic myelopathy
Supplemental Digital Content
© 2013 by Lippincott Williams & Wilkins