Neck Disability Index

Definition[edit | edit source]

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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.