The Neck Disability Index:
A Study of Reliability and Validity

This section was compiled by Frank M. Painter, D.C.
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FROM:   J Manipulative Physiol Ther 1991 (Sep);   14 (7):   409415

Vernon H, Mior S

Division of Research,
Canadian Memorial Chiropractic College,
Toronto, Ontario

Injuries to the cervical spine, especially those involving the soft tissues, represent a significant source of chronic disability. Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, are few in number.

A modification of the Oswestry Low Back Pain Index was conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI). Face validity was ensured through peer-review and patient feedback sessions. Test-retest reliability was conducted on an initial sample of 17 consecutive "whiplash"-injured patients in an outpatient clinic, resulting in good statistical significance (Pearson's r = 0.89, p less than or equal to .05). The alpha coefficients were calculated from a pool of questionnaires completed by 52 such subjects resulting in a total index alpha of 0.80, with all items having individual alpha scores above 0.75.

Concurrent validity was assessed in two ways. First, on a smaller subset of 10 patients who completed a course of conservative care, the percentage of change on NDI scores before and after treatment was compared to visual analogue scale scores of percent of perceived improvement in activity levels. These scores correlated at 0.60.

Secondly, in a larger subset of 30 subjects, NDI scores were compared to scores on the McGill Pain Questionnaire, with similar moderately high correlations (0.69-0.70). While the sample size of some of the analyses is somewhat small, this study demonstrated that the NDI achieved a high degree of reliability and internal consistency.

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