Neck Disability Index: Difference between revisions

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'''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]], [[User:Sean Wauters|Sean Wauters]]  
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= Searchstrategy =
== Definition ==
 
[[File:Afif-kusuma-txzpx9doVWs-unsplash.jpg|right|frameless]]
By using the database pubmed i was able to collect several articles about the NDI.&nbsp;
The Neck Disability Index (NDI) (modification of the [[Oswestry Disability Index|Oswestry Low Back Pain Disability Index]]).  
 
* Patient-completed, condition-specific functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation.  
Fist I collected the articles that were used by the previous editor so I was able to check the reliability of the current information. There for I checked and corrected possible mistakes of misinterpretations. I searched on pubmed by using the references used&nbsp;in the article.&nbsp;<br>Secondly I searched for more reliable information about the NDI on pubmed by combining different keyword, using advanced search. I used head keywords like [Title], [Title/abstract], etc.
* The NDI has sufficient support and usefulness to retain its current status as the most commonly used self-report measure for neck pain <ref name="Macdermid et al">Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Measurement properties of the neck disability index a sustematic review Journal of Orthopedic and Sports Physical Therapy. 2009 May;39(5):400-17.</ref>.&nbsp;
 
* The NDI is translated in many languages (Greek, German, Dutch, Korean, Spanish, French) each has its own validity and reliability outcomes.  
Main keywords I used were:<br>• Neck Disability Index<br>• Reliability <br>• Validity<br>• responsiveness <br>• method of use
* The NDI can be used to evaluate the patients status presence and to evaluate the evolution during the therapy
 
I also checked references who were mentioned in the RCT’s I collected from pubmed. <br>By using systematic reviews and RCT’s I was able to collect a large amount of information which I combined to write this text about the NDI.<br>
 
= Definition<br> =
 
The NDI is a modification of the [[Oswestry Disability Index|Oswestry Low Back Pain Disability Index]]&nbsp;. It is a patient-completed, condition-specific functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation. The NDI has sufficient support and usefulness to retain its current status as the most commonly used self-report measure for neck pain <ref name="Macdermid et al">Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Measurement properties of the neck disability index a sustematic review Journal of Orthopedic and Sports Physical Therapy. 2009 May;39(5):400-17.</ref>.&nbsp;  
 
The NDI is translated in many languages (greek, german, dutch, Korean, Spanish, frensh…) each has its own validity and reliability outcomes. Because there is an impact of translation on validity. <br>The NDI can be used to evaluate the patients status presence and to evaluate the evolution during the therapy  
 
<br>
 
= Intended Population <ref name="Macdermid et al" /> =
 
*Chronic neck pain
*musculoskeletal neck pain
*whiplash injuries and [[Whiplash Associated Disorders|whiplash associated disorders]]
*[[Cervical Radiculopathy|cervical radiculopathy]]
 
= Method of Use<br> =
 
The NDI can be scored as raw score <ref name="Vernon et al" />or doubled, and expressed as a percent <ref name="Riddle & Stratford">Riddle DL, Stratford PW. Use of generic versus region specific functional status measures on patients with cervical spine disorders. Physical Therapy, 1998;78:951-963</ref>. Each section is scored on a 0-5 scale, with the first statement being “0” (ie. No pain) and the last statement being “5” (ie. Worst imaginable pain).&nbsp;Al the points are than summed. Interpretation of the test can be numeric form 0 points to 50 points. It can also be calculated in percentages.<br>0 points or 0% means&nbsp;: no activity limitations , <br>50points or 100% means complete activity limitation.
 
A higher score indicates more patient-rated disability. There is no statement in the original literature on how to handle missing data. To use the NDI for patient decisions, a clinically important change was calculated as 5 points, with a sensitivity of 0.78 and a specificity of 0.80<ref name="Stratford et al">Stratford PW, Riddle DL, Binkley JM et al (1999) Using the neck disability index to make decisions concerning individual patients Physiotherapy Canada, 2,107-112</ref>.
 
Mean duration of the test: 3 to 7.8 minutes <ref name="Macdermid et al" /><br>Some benchmarks can be found in literature but methodologically they were not described and theire validity and reliability are questionable Vernon and Moir presented the following interpretation:<ref name="Macdermid et al" /><br>• 0-4points (0-8%) no disability, <br>• 5-14points ( 10 – 28%) mild disability, <br>• 15-24points (30-48% ) moderate disability, <br>• 25-34points (50- 64%) severe disability,<br>• 35-50points (70-100%) complete disability<br>
 
= Evidence  =
 
== Reliability  ==
 
Definition&nbsp;: test-retest reliability. When an instrument is tested on two different occasions the reslads should be comparable and preferably identical. The intraclass correlation coefficients between the two results is than calculated.&nbsp;
 
• Intra-examiner reliability: when two or more tests were preformed by the same executor. This consists the stability of the variables.Because there is no operator involved the intra-examiner reliability is not relevant. This is a patient controlled questionnaire. <br>• Inter-examiner reliability: when to different executors test the same variable. This consist the objectiveness of the tests. Because there is no operator involved the intra-examiner reliability is not relevant. This is a patient controlled questionnaire. <br>• Internal consistency&nbsp;: do the different parts of the test correlate. Are the different parts related to one another: NDI has a reasonable internal consistency³
 
The NDI has a fair to moderate test-retest reliability in patients with mechanical neck pain but also for patients with [[Cervical Radiculopathy|cervical radiculopathy]] .&nbsp;<ref name="Cleland et al">Cleland JA, Childs JD, Whitman JM.. Psychometric Properties of the Neck Disability Index and Numeric Pain Rating Scale in patients With Mechanical Neck Pain, Arch Phys Med Rehabil. 2008; 89(1):69-74</ref>,<ref name="Young et al 2">Young IA, Cleland JA, Michener LA, Brown C. Reliability, Construct Validity, and Responsiveness of the Neck Disability Index, Patient-Specific Functional Scale, and Numeric Pain Rating Scale in Patients with Cervical Radiculopathy, American Journal of Physical Medicine &amp;amp;amp;amp;amp; Rehabilitation, 2010; ;89(10):831-839</ref>. although intraclass correlations can change between 0,50 and 0,98 . These difference may occur because some studies do not separate chronic or acute neck pain or due to the fact that the study only used patients with acute neck pain and the retestinterval was 72 hours <ref name="Macdermid et al" />.
 
== Validity  ==
 
Definition: <br>Validity: Does the instrument measure what it is suppose to measure. <br>Content validity: validity of an instruments content<br>Construct validity: validity of subjective construct like pain.&nbsp;
 
Validity is tested in different trails by comparing NDI with different instruments:


*The PET
== Intended Population  ==
*the Visual Analogue scale.
*The Northwick Park Neck Pain Questionnaire: NPNQ
*The [[Patient Specific Functional Scale|Patient-specific Functional Scale]]: PSFS: [[|]]
*The Disability Rating Index&nbsp;: DRI <br>


They all had strong correlation coefficients suggesting there content is highly comparable: The NDI has a good construct validity.<ref name="Vernon et al">Vernon H, Mior S. The neck disability index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 1991, 14:409-15</ref><ref name="Hoving et al">Jan lucas hoving, Elizabeth F o’leary, ken r niere, sally green, Rachelle buchbinder, Validity of the neck disability index, Northwick park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders, pain,2003;102(3); 273-281</ref><ref name="Young et al 2" /><br><br>The NDI is seen as a valide tool to measure neck pain and disabilities in patients with neck pain due to acute or chronic conditions as well as in patients suffering from musculoskeletal dysfunctions, [[Whiplash Associated Disorders|whiplash - associated disorders]] and [[Cervical Radiculopathy|cervical radiculopathy]].&nbsp;<ref name="Stratford et al" /><ref name="Macdermid et al" />  
*Chronic neck or upper back pain  
*Musculoskeletal neck pain  
*Whiplash injuries and [[Whiplash Associated Disorders|whiplash associated disorders]]  
*[[Cervical Radiculopathy|Cervical radiculopathy]] and [[Thoracic Disc Syndrome]]<ref name="Macdermid et al" />


== Responsiveness ==
== NDI Questionnaire ==
Below is the questionnaire.


The NDI appears to demonstrate adequate responsiveness in patients with neck pain and concomitant upper extrmity referred symptoms. Young et al suggest that a 10-point change should be used as the minimum clinically important difference.<br><ref name="Young et al">Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine, 2009 Jul 24, online article ahead of print.</ref>.  
This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the one box that applies to you. We realise you may consider that two or more statements in any one section relate to you, but please just mark the box that most closely describes your problem.


MCID-MCIC: the minimal clinically important difference or change (MCID / MCIC) is described as the smallest difference or change that patients perceive as beneficial.<ref name="Vernon et al" />. In patients with musculoskeletal related complaints MCID can be said to occur when the changes are over 5 points of change (10%)<br>In patients with [[Cervical Radiculopathy|cervical radiculopathy]] the MCID has to be over 7 points of change ( 14%)<ref name="Young et al 2" /><ref name="Macdermid et al" /> . When a decrease in score occurs the patients disabilities decrease so the patients situation improves.&nbsp;
Section 1: Pain Intensity
* I have no pain at the moment
* The pain is very mild at the moment
* The pain is moderate at the moment
* The pain is fairly severe at the moment
* The pain is very severe at the moment
* The pain is the worst imaginable at the moment
Section 2: Personal Care (Washing, Dressing, etc.)
* I can look after myself normally without causing extra pain
* I can look after myself normally but it causes extra pain
* It is painful to look after myself and I am slow and careful
* I need some help but can manage most of my personal care
* I need help every day in most aspects of self care
* I do not get dressed, I wash with difficulty and stay in bed
Section 3: Lifting
* I can lift heavy weights without extra pain
* I can lift heavy weights but it gives extra pain
* Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed, for example on a table
* Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned
* I can only lift very light weights
* I cannot lift or carry anything
Section 4: Reading
* I can read as much as I want to with no pain in my neck
* I can read as much as I want to with slight pain in my neck
* I can read as much as I want with moderate pain in my neck
* I can’t read as much as I want because of moderate pain in my neck
* I can hardly read at all because of severe pain in my neck
* I cannot read at all
Section 5: Headaches
* I have no headaches at all
* I have slight headaches, which come infrequently
* I have moderate headaches, which come infrequently
* I have moderate headaches, which come frequently
* I have severe headaches, which come frequently
* I have headaches almost all the time
Section 6: Concentration
* I can concentrate fully when I want to with no difficulty
* I can concentrate fully when I want to with slight difficulty
* I have a fair degree of difficulty in concentrating when I want to
* I have a lot of difficulty in concentrating when I want to
* I have a great deal of difficulty in concentrating when I want to
* I cannot concentrate at all
Section 7: Work
* I can do as much work as I want to
* I can only do my usual work, but no more
* I can do most of my usual work, but no more
* I cannot do my usual work
* I can hardly do any work at all
* I can’t do any work at all
Section 8: Driving
* I can drive my car without any neck pain
* I can drive my car as long as I want with slight pain in my neck
* I can drive my car as long as I want with moderate pain in my neck
* I can’t drive my car as long as I want because of moderate pain in my neck
* I can hardly drive at all because of severe pain in my neck
* I can’t drive my car at all
Section 9: Sleeping
* I have no trouble sleeping
* My sleep is slightly disturbed (less than 1 hr sleepless)
* My sleep is mildly disturbed (1-2 hrs sleepless)
* My sleep is moderately disturbed (2-3 hrs sleepless)
* My sleep is greatly disturbed (3-5 hrs sleepless)
* My sleep is completely disturbed (5-7 hrs sleepless)
Section 10: Recreation
* I am able to engage in all my recreation activities with no neck pain at all
* I am able to engage in all my recreation activities, with some pain in my neck
* I am able to engage in most, but not all of my usual recreation activities because of pain in my neck
* I am able to engage in a few of my usual recreation activities because of pain in my neck
* I can hardly do any recreation activities because of pain in my neck
* I can’t do any recreation activities at all
Score: /50 Transform to percentage score x 100 = %points


MDC: the minimal detectable change (MDC), described as the amount of change that must be observed before the change can be considered to exceed the measurement error<ref name="Hoving et al" /> . In other words: Are the changes really caused by a changing of the patient or merely due to measurement errors?<br>There are some contradictions about the MDC for the NDI. The most common estimation is 5 out of 50 points or 10%. Other trains&nbsp;report higher MDC for patients with [[Cervical Radiculopathy|cervical radiculopathy]]&nbsp;: 13.4 points out of 50&nbsp;or 26.8%.<ref name="Cleland et al" />
Scoring: For each section the total possible score is 5: if the first statement is marked the section score = 0, if the last statement is marked it = 5. If all ten sections are completed the score is calculated


The NDI appears to have good responsiveness in measuring neck pain and disabilities in patients with neck pain due to acute or chronic conditions as well as patients suffering from musculoskeletal dysfunctions, [[Whiplash Associated Disorders|whiplash associated disorders]] and [[Cervical Radiculopathy|cervical radiculopathy]] <ref name="Macdermid et al" /><br>
Minimum Detectable Change (90% confidence): 5 points or 10 %points<ref>NDI developed by: Vernon, H. & Mior, S. (1991). The Neck Disability Index: https://www.sralab.org/rehabilitation-measures/neck-disability-index. Journal of Manipulative and Physiological Therapeutics. 14, 409-415 Available from:https://www.sralab.org/rehabilitation-measures/neck-disability-index (last accessed 1.5.2020)</ref>


= Miscellaneous =
== Method of Use ==


== Identifided problems ==
The NDI can be scored as a&nbsp;raw score <ref name="Vernon et al" />or doubled and expressed as a percent <ref name="Riddle & Stratford">Riddle DL, Stratford PW. Use of generic versus region specific functional status measures on patients with cervical spine disorders. Physical Therapy, 1998;78:951-963</ref>.  
* Each section is scored on a 0 to 5 rating scale, in which zero means 'No pain' and 5 means&nbsp;'Worst imaginable pain'.&nbsp;
* Points summed to a total score. 
* The test can be interpreted as a raw score, with a maximum score of 50, or as a percentage.
* 0 points or 0% means&nbsp;: no activity limitations , 
* 50 points or 100% means complete activity limitation.
* A higher score indicates more patient-rated disability. There is no statement in the original literature on how to handle missing data. To use the NDI for patient decisions, a clinically important change was calculated as 5 points, with a sensitivity of 0.78 and a specificity of 0.80<ref name="Stratford et al">Stratford PW, Riddle DL, Binkley JM et al (1999) Using the neck disability index to make decisions concerning individual patients Physiotherapy Canada, 2,107-112</ref>.
* Mean duration of the test: 3 to 7.8 minutes <ref name="Macdermid et al" />
Some benchmarks can be found in literature <ref name="Macdermid et al" />
* 0-4points (0-8%) no disability,
* 5-14points ( 10 – 28%) mild disability,
* 15-24points (30-48% ) moderate disability,
* 25-34points (50- 64%) severe disability,
* 35-50points (70-100%) complete disability


<br>The neck disability Index does not include psychosocial and emotional aspects of neck disabilities although these are very common in chronic neck pain ,whiplash [[Whiplash_Associated_Disorders|associated disorders]] and [[Cervical_Radiculopathy|Cervical Radiculopathy]]. These psychosocial and emotional ([[Biopsychosocial|Biopsychosocial]]) aspects can be identified by the problem elicitation technique PET:&nbsp;
== Evidence  ==
'''Reliability'''


There are no valid benchmarks of the NDI.  
The NDI has a fair to moderate test-retest reliability in patients with mechanical neck pain but also for patients with [[Cervical Radiculopathy|cervical radiculopathy]] .&nbsp;<ref name="Cleland et al">Cleland JA, Childs JD, Whitman JM.. Psychometric Properties of the Neck Disability Index and Numeric Pain Rating Scale in patients With Mechanical Neck Pain, Arch Phys Med Rehabil. 2008; 89(1):69-74</ref>,<ref name="Young et al 2">Young IA, Cleland JA, Michener LA, Brown C. Reliability, Construct Validity, and Responsiveness of the Neck Disability Index, Patient-Specific Functional Scale, and Numeric Pain Rating Scale in Patients with Cervical Radiculopathy, American Journal of Physical Medicine &amp; Rehabilitation, 2010; ;89(10):831-839</ref>. although intra class correlations can change between 0,50 and 0,98 . These difference may occur because some studies do not separate chronic or acute neck pain or due to the fact that the study only used patients with acute neck pain and the retestinterval was 72 hours <ref name="Macdermid et al" />.  


== <br>List of other tools:  ==
'''Validity'''
* Validity is tested in different trails by comparing NDI with different instruments: eg VAS, [[Patient Specific Functional Scale|Patient-specific Functional Scale]], The Disability Rating Index.
* They all had strong correlation coefficients suggesting their content is highly comparable: The NDI has a good construct validity.<ref name="Vernon et al">Vernon H, Mior S. The neck disability index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 1991, 14:409-15</ref><ref name="Hoving et al">Jan lucas hoving, Elizabeth F o’leary, ken r niere, sally green, Rachelle buchbinder, Validity of the neck disability index, Northwick park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders, pain,2003;102(3); 273-281</ref><ref name="Young et al 2" />
* The NDI is seen as a valid tool to measure neck pain and disabilities in patients with neck pain due to acute or chronic conditions as well as in patients suffering from musculoskeletal dysfunctions, [[Whiplash Associated Disorders|whiplash - associated disorders]] and [[Cervical Radiculopathy|cervical radiculopathy]].&nbsp;<ref name="Stratford et al" /><ref name="Macdermid et al" />
'''Responsiveness'''


*<ref name="Hoving et al" /><ref name="Gay et al">Gay RE, Madson TJ, Cieslak KR.. COMPARISON OF THE NECK DISABILITY INDEX AND THE NECK BOURNEMOUTH QUESTIONNAIRE IN A SAMPLE OF PATIENTS WITH CHRONIC UNCOMPLICATED NECK PAIN., Journal of Manipulative and Physiological Therapeutics,2007. 30 (4): 259–262</ref><ref name="Pool et al">Pool, Jan J. M. PhD, PT, MT*; Ostelo, Raymond W. J. G. PhD*†; Hoving, Jan L. PhD*‡; Bouter, Lex M. PhD*; de Vet, Henrica C. W. PhD*. Minimal Clinically Important Change of the Neck Disability Index and the Numerical Rating Scale for Patients With Neck Pain, spine, 2007; 32(26) ; 3047-3051</ref><ref name="Cleland et al" /><ref name="Young et al 2" /><ref name="Macdermid et al" />
The NDI
*&nbsp;copenhagen neck functional disability scale
*problem elicitation technique
*&nbsp;NPQ
*neck Bornemouth questionnaire
*[[Short-form McGill Pain Questionnaire|mc Gill pain questionnaire]]
*Visual analoge scale
*Numeric rating scale
*[[Patient Specific Functional Scale|Patient-Specific Functional Scale]]
*General health questionnaire
*[[Oswestry Disability Index|Oswestry Low Back Pain Index]]<br>


= Links  =
Good responsiveness in measuring neck pain and disabilities in patients with neck pain due to acute or chronic conditions as well as patients suffering from musculoskeletal dysfunctions, [[Whiplash Associated Disorders|whiplash associated disorders]] and [[Cervical Radiculopathy|cervical radiculopathy]] <ref name="Macdermid et al" />


== view Neck Disability Index ==
Demonstrate adequate responsiveness in patients with neck pain and concomitant upper extremity referred symptoms. Young et al suggest that a 10-point change should be used as the minimum clinically important difference.<ref name="Young et al">Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine, 2009 Jul 24, online article ahead of print.</ref>.
[[File:Nik-shuliahin-BuNWp1bL0nc-unsplash.jpg|right|frameless]]


[http://academic.regis.edu/clinicaleducation/pdf%27s/NDI_with_scoring.pdf View Neck Disability Index]
== Identified problems ==
<div class="researchbox"></div>
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==


<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1NwSQ1kPYoZ1BHXGyok_x3pfuZCMJvIb52XKsd8pCQejfeXAV|charset=UTF-8|short|max=10</rss>&nbsp;&nbsp;&nbsp;
Does not include
* Psychosocial aspects
* Emotional aspects
Very common in:  
* Chronic neck pain
* Whiplash [[Whiplash Associated Disorders|associated disorders]]
* [[Cervical Radiculopathy|Cervical Radiculopathy]]
== References  ==


= References  =
<references />


References will automatically be added here, see [[Adding References|adding references tutorial]].
[[Category:Outcome_Measures]]
[[Category:Cervical Spine - Outcome Measures]]
[[Category:Thoracic Spine - Outcome Measures]]


<references />
[[Category:Thoracic Spine]]

Latest revision as of 11:43, 15 November 2023

Original Editor - Rachael Lowe, Sean Wauters

Top Contributors - Sean Wauters, Rachael Lowe, Laura Bronckaerts, Admin, Kim Jackson, Lucinda hampton, Ammar Suhail, Simisola Ajeyalemi, Jess Bell, 127.0.0.1, Rafet Irmak, Laura Ritchie and WikiSysop  

Definition[edit | edit source]

Afif-kusuma-txzpx9doVWs-unsplash.jpg

The Neck Disability Index (NDI) (modification of the Oswestry Low Back Pain Disability Index).

  • Patient-completed, condition-specific functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation.
  • The NDI has sufficient support and usefulness to retain its current status as the most commonly used self-report measure for neck pain [1]. 
  • The NDI is translated in many languages (Greek, German, Dutch, Korean, Spanish, French) each has its own validity and reliability outcomes.
  • The NDI can be used to evaluate the patients status presence and to evaluate the evolution during the therapy

Intended Population[edit | edit source]

NDI Questionnaire[edit | edit source]

Below is the questionnaire.

This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the one box that applies to you. We realise you may consider that two or more statements in any one section relate to you, but please just mark the box that most closely describes your problem.

Section 1: Pain Intensity

  • I have no pain at the moment
  • The pain is very mild at the moment
  • The pain is moderate at the moment
  • The pain is fairly severe at the moment
  • The pain is very severe at the moment
  • The pain is the worst imaginable at the moment

Section 2: Personal Care (Washing, Dressing, etc.)

  • I can look after myself normally without causing extra pain
  • I can look after myself normally but it causes extra pain
  • It is painful to look after myself and I am slow and careful
  • I need some help but can manage most of my personal care
  • I need help every day in most aspects of self care
  • I do not get dressed, I wash with difficulty and stay in bed

Section 3: Lifting

  • I can lift heavy weights without extra pain
  • I can lift heavy weights but it gives extra pain
  • Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed, for example on a table
  • Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned
  • I can only lift very light weights
  • I cannot lift or carry anything

Section 4: Reading

  • I can read as much as I want to with no pain in my neck
  • I can read as much as I want to with slight pain in my neck
  • I can read as much as I want with moderate pain in my neck
  • I can’t read as much as I want because of moderate pain in my neck
  • I can hardly read at all because of severe pain in my neck
  • I cannot read at all

Section 5: Headaches

  • I have no headaches at all
  • I have slight headaches, which come infrequently
  • I have moderate headaches, which come infrequently
  • I have moderate headaches, which come frequently
  • I have severe headaches, which come frequently
  • I have headaches almost all the time

Section 6: Concentration

  • I can concentrate fully when I want to with no difficulty
  • I can concentrate fully when I want to with slight difficulty
  • I have a fair degree of difficulty in concentrating when I want to
  • I have a lot of difficulty in concentrating when I want to
  • I have a great deal of difficulty in concentrating when I want to
  • I cannot concentrate at all

Section 7: Work

  • I can do as much work as I want to
  • I can only do my usual work, but no more
  • I can do most of my usual work, but no more
  • I cannot do my usual work
  • I can hardly do any work at all
  • I can’t do any work at all

Section 8: Driving

  • I can drive my car without any neck pain
  • I can drive my car as long as I want with slight pain in my neck
  • I can drive my car as long as I want with moderate pain in my neck
  • I can’t drive my car as long as I want because of moderate pain in my neck
  • I can hardly drive at all because of severe pain in my neck
  • I can’t drive my car at all

Section 9: Sleeping

  • I have no trouble sleeping
  • My sleep is slightly disturbed (less than 1 hr sleepless)
  • My sleep is mildly disturbed (1-2 hrs sleepless)
  • My sleep is moderately disturbed (2-3 hrs sleepless)
  • My sleep is greatly disturbed (3-5 hrs sleepless)
  • My sleep is completely disturbed (5-7 hrs sleepless)

Section 10: Recreation

  • I am able to engage in all my recreation activities with no neck pain at all
  • I am able to engage in all my recreation activities, with some pain in my neck
  • I am able to engage in most, but not all of my usual recreation activities because of pain in my neck
  • I am able to engage in a few of my usual recreation activities because of pain in my neck
  • I can hardly do any recreation activities because of pain in my neck
  • I can’t do any recreation activities at all

Score: /50 Transform to percentage score x 100 = %points

Scoring: For each section the total possible score is 5: if the first statement is marked the section score = 0, if the last statement is marked it = 5. If all ten sections are completed the score is calculated

Minimum Detectable Change (90% confidence): 5 points or 10 %points[2]

Method of Use[edit | edit source]

The NDI can be scored as a raw score [3]or doubled and expressed as a percent [4].

  • Each section is scored on a 0 to 5 rating scale, in which zero means 'No pain' and 5 means 'Worst imaginable pain'. 
  • Points summed to a total score.
  • The test can be interpreted as a raw score, with a maximum score of 50, or as a percentage.
  • 0 points or 0% means : no activity limitations ,
  • 50 points or 100% means complete activity limitation.
  • A higher score indicates more patient-rated disability. There is no statement in the original literature on how to handle missing data. To use the NDI for patient decisions, a clinically important change was calculated as 5 points, with a sensitivity of 0.78 and a specificity of 0.80[5].
  • Mean duration of the test: 3 to 7.8 minutes [1]

Some benchmarks can be found in literature [1]

  • 0-4points (0-8%) no disability,
  • 5-14points ( 10 – 28%) mild disability,
  • 15-24points (30-48% ) moderate disability,
  • 25-34points (50- 64%) severe disability,
  • 35-50points (70-100%) complete disability

Evidence[edit | edit source]

Reliability

The NDI has a fair to moderate test-retest reliability in patients with mechanical neck pain but also for patients with cervical radiculopathy . [6],[7]. although intra class correlations can change between 0,50 and 0,98 . These difference may occur because some studies do not separate chronic or acute neck pain or due to the fact that the study only used patients with acute neck pain and the retestinterval was 72 hours [1].

Validity

  • Validity is tested in different trails by comparing NDI with different instruments: eg VAS, Patient-specific Functional Scale, The Disability Rating Index.
  • They all had strong correlation coefficients suggesting their content is highly comparable: The NDI has a good construct validity.[3][8][7]
  • The NDI is seen as a valid tool to measure neck pain and disabilities in patients with neck pain due to acute or chronic conditions as well as in patients suffering from musculoskeletal dysfunctions, whiplash - associated disorders and cervical radiculopathy. [5][1]

Responsiveness

The NDI

Good responsiveness in measuring neck pain and disabilities in patients with neck pain due to acute or chronic conditions as well as patients suffering from musculoskeletal dysfunctions, whiplash associated disorders and cervical radiculopathy [1]

Demonstrate adequate responsiveness in patients with neck pain and concomitant upper extremity referred symptoms. Young et al suggest that a 10-point change should be used as the minimum clinically important difference.[9].

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Identified problems[edit | edit source]

Does not include

  • Psychosocial aspects
  • Emotional aspects

Very common in:

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Measurement properties of the neck disability index a sustematic review Journal of Orthopedic and Sports Physical Therapy. 2009 May;39(5):400-17.
  2. ↑ NDI developed by: Vernon, H. & Mior, S. (1991). The Neck Disability Index: https://www.sralab.org/rehabilitation-measures/neck-disability-index. Journal of Manipulative and Physiological Therapeutics. 14, 409-415 Available from:https://www.sralab.org/rehabilitation-measures/neck-disability-index (last accessed 1.5.2020)
  3. ↑ 3.0 3.1 Vernon H, Mior S. The neck disability index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 1991, 14:409-15
  4. ↑ Riddle DL, Stratford PW. Use of generic versus region specific functional status measures on patients with cervical spine disorders. Physical Therapy, 1998;78:951-963
  5. ↑ 5.0 5.1 Stratford PW, Riddle DL, Binkley JM et al (1999) Using the neck disability index to make decisions concerning individual patients Physiotherapy Canada, 2,107-112
  6. ↑ Cleland JA, Childs JD, Whitman JM.. Psychometric Properties of the Neck Disability Index and Numeric Pain Rating Scale in patients With Mechanical Neck Pain, Arch Phys Med Rehabil. 2008; 89(1):69-74
  7. ↑ 7.0 7.1 Young IA, Cleland JA, Michener LA, Brown C. Reliability, Construct Validity, and Responsiveness of the Neck Disability Index, Patient-Specific Functional Scale, and Numeric Pain Rating Scale in Patients with Cervical Radiculopathy, American Journal of Physical Medicine & Rehabilitation, 2010; ;89(10):831-839
  8. ↑ Jan lucas hoving, Elizabeth F o’leary, ken r niere, sally green, Rachelle buchbinder, Validity of the neck disability index, Northwick park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders, pain,2003;102(3); 273-281
  9. ↑ Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine, 2009 Jul 24, online article ahead of print.
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