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Translation and linguistic validation of the international standards to document autonomic function following spinal cord injury (ISAFSCI) for Japanese healthcare professionals

Spinal Cord volume 64, pages 258–265 (2026)Cite this article

Subjects

Abstract

Study Design

Forward and backward translation processes were conducted first, followed by cognitive interviews for validation within a cross-sectional study design.

Objective

To translate the second edition (2021) of the International Standards to document Autonomic Function after Spinal Cord Injury (ISAFSCI) from English to Japanese using established translation guidelines.

Setting

Department of Rehabilitation Medicine, University of Washington. Cognitive interviews were conducted in person or via secure video conferencing.

Methods

The second edition (2021) of the ISAFSCI was translated into Japanese by two groups of bilingual Japanese healthcare professionals, and then back translated to English independently. After iterative review and confirmation by the developer, a pre-final version was created. Cognitive interviews were conducted with 15 Japanese healthcare professionals practicing spinal cord injury (SCI) care.

Results

All aspects of the ISAFSCI were translated including survey items (n = 114) and instructional items (n = 111). During back-translation, 10.7% of items showed language discrepancies. These were resolved through a second round of expert committee review and developer evaluation. Cognitive interviews revealed that most items were well understood. Modifications (n = 19) were required to clarify expressions related to autonomic function and anatomical terminology.

Conclusion

Following a rigorous translation process, the Japanese version of the second ISAFSCI edition 2021 demonstrated linguistic clarity, cultural relevance, and broad comprehensibility among Japanese healthcare professionals. In addition to its clinical and research utility, this survey could address the knowledge gap about autonomic dysfunction after SCI by promoting awareness and education in the Japanese healthcare community.

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Fig. 1: Flow chart of translation and linguistic validation procedures.
Fig. 2: Revision and cognitive interview outcomes.

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Data availability

The datasets analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors gratefully acknowledge the Japan Medical Society of Spinal Cord Lesion and Dr. Masaya Nakamura, the president of the society, for the entire support and collaboration with the American Spinal Injury Association (ASIA). We would also like to thank Drs. Hiroki Okawara and Tomonori Sawada, the Keio University School of Medicine for the initiation of this study. Furthermore, we extend our sincere appreciation to the ASIA for their endorsement and continued efforts in promoting the international standardization of autonomic function assessment following SCI.

Funding

SS is supported by the Wings for Life Spinal Cord Research Foundation, Foundation for Physical Therapy Research, Craig H. Neilsen Foundation, Mission Yogurt Fund, and Morton Cure Paralysis Fund. RN is supported by Nakatomi Foundation, Foundation for Physical Therapy Research, and Craig H Neilsen Foundation. AVK holds Patrik Reid Endowed Chair in Spinal Cord Rehabilitation Research, University of British Columbia, and his lab is supported by funds from the Canadian Institutes for Health Research, Canada Foundation for Innovation and BC Knowledge Development Fund, International Spinal Research Trust, Rick Hansen Foundation, PRAXIS Spinal Cord Institute, Craig H. Neilsen Foundation, Wings for Life Research Foundation, and US Department of Defense.

Author information

Authors and Affiliations

  1. Dpartment of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    Ryo Nakahara & Soshi Samejima

  2. Department of Rehabilitation, Hokkaido Spinal Cord Injury Center, Hokkaido, Japan

    Yousuke Tanaka & Kotaro Kojima

  3. Department of Physical Therapy, Faculty of Rehabilitation, Morinomiya University of Medical Sciences, Osaka, Japan

    Hajime Miyashita

  4. Department of Rehabilitation, Hoshigaoka Medical Center, Japan Community Health care Organization (JCHO), Osaka, Japan

    Hajime Miyashita

  5. Department of Rehabilitation, Iwate Prefectural Central Hospital, Iwate, Japan

    Hiroki Sato

  6. Department of Rehabilitation, Kanagawa University of Human Services, Kanagawa, Japan

    Naoki Asai

  7. Division of Rehabilitation, Sapporo Medical University Hospital, Hokkaido, Japan

    Tatsuro Yamashita

  8. Department of Rehabilitation Medicine, Edmonton General Continuing Care Centre, Edmonton, AB, Canada

    Yoko Bourne

  9. Motion Sports Medicine, Rye, NY, USA

    Miyako Kobayashi

  10. International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada

    Claire Shackleton, Andrei V. Krassioukov & Soshi Samejima

  11. Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Claire Shackleton & Andrei V. Krassioukov

  12. University of Texas Health Houston, McGovern Medical School, Houston, TX, USA

    Claire Shackleton

  13. Department of PM&R, UTHealth McGovern Medical School, Houston, TX, USA

    Claire Shackleton

  14. GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada

    Andrei V. Krassioukov

Authors
  1. Ryo Nakahara
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  2. Yousuke Tanaka
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Contributions

Conceptualization, RN and SS; Data collection, RN, YT, TK, and SS; Translation process, HM, HS, NA, TY, YB, M.K., and AVK; Data analysis, RN; Writing of the original draft manuscript and creation of figures, RN and SS; Manuscript review and editing, RN, YT, TK, HM, HS, NA, TY, YB, MK, CS, AVK, and SS; Supervision, SS All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Soshi Samejima.

Ethics declarations

Ethical approval

The project was approved by the University of Washington Human Subjects Division [Approval number; STUDY00022450]. All methods were performed in accordance with the relevant guidelines and regulations.

Competing interests

The authors declare no competing interests.

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Nakahara, R., Tanaka, Y., Kojima, K. et al. Translation and linguistic validation of the international standards to document autonomic function following spinal cord injury (ISAFSCI) for Japanese healthcare professionals. Spinal Cord 64, 258–265 (2026). https://doi.org/10.1038/s41393-026-01173-6

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