Neck Disability Index

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Objective
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The NDI is a modification of the Oswestry Low Back Pain Disability Index  www.physio-pedia.com/index.php5. 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 [1]. 

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.
The NDI can be used for evaluating the patients status praeses and evolution during the therapy (intended population).[1]

Intended Population[edit | edit source]

Chronic neck pain, musculoskeletal neck pain and whiplash injuries.

Method of Use
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The NDI can be scored as raw score [2]or doubled, and expressed as a percent [3]. 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). 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.
0 points or 0% means : no activity limitations ,
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[4].

Mean duration of the test: 3 to 7.8 minutes [1]
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:[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[edit | edit source]

Definition : 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. 

• 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.
• 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.
• Internal consistency : 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. www.physio-pedia.com/index.php5. [5],[6]. 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 [1].

Validity[edit | edit source]

Definition:
Validity: Does the instrument measure what it is suppose to measure.
Content validity: validity of an instruments content
Construct validity: validity of subjective construct like pain. 

Validity is tested in different trails by comparing NDI with different instruments:

  • The PET
  • the Visual Analogue scale.
  • The Northwick Park Neck Pain Questionnaire: NPNQ
  • The Patient-specific Functional Scale: PSFS:
  • The Disability Rating Index : DRI

They all had strong correlation coefficients suggesting there content is highly comparable: The NDI has a good construct validity.
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 (link: http://www.physio-pedia.com/index.php5?title=Whiplash_Associated_Disorders) and cervical radiculopathy. Template:Http://www.physio-pedia.com/index.php5?title=Cervical RadiculopathyLink naar stephanie 4,13

Responsiveness[edit | edit source]

The NDI appears to demonstrate adequate responsiveness in patients with neck pain and concomitant upper extrmity referred symptoms[6]. Young et al [6] suggest that a 10-point change should be used as the minimum clinically important difference.


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[3]

Miscellaneous[edit | edit source]

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[4].

Jette DU, Jette AM (1996) Physical therapy and health outcomes in patients with spinal impairments. Physical Therapy 76, 930-45[7]

Links[edit | edit source]

View Neck Disability Index

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ 1.0 1.1 1.2 1.3 1.4 Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Journal of Orthopedic and Sports Physical Therapy. 2009 May;39(5):400-17.
  2. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Vernon & Mior
  3. ↑ 3.0 3.1 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
  4. ↑ 4.0 4.1 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.
  5. ↑ 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
  6. ↑ 6.0 6.1 6.2 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 & Rehabilitation, 2010; ;89(10):831-839 Cite error: Invalid <ref> tag; name "Young et al" defined multiple times with different content
  7. ↑ Jette DU, Jette AM. Physical therapy and health outcomes in patients with spinal impairments. Physical Therapy, 1996; 76:930-45
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