ARTICLE IN PRESS

Manual Therapy xxx (2008) 1-6

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Manual Therapy
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Original Article

Validity of the Neck Disability Index and Neck Pain and Disability Scale
for measuring disability associated with chronic, non-traumatic neck pain
Mark Chan Ci Ena, Dean A. Clairb, Stephen J. Edmondstonc,*
a
Physiotherapy Department, Tan Tock Seng Hospital, Singapore
b
Physiotherapy Department, Osborne Park Hospital, WA, Australia
c
School of Physiotherapy, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia

articleinfo abstract

Article history: The purpose of this study was to evaluate the construct and content validity of the Neck Disability Index
Received 17 January 2008 (NDI) and the Neck Pain and Disability Scale (NPAD) in patients with chronic, non-traumatic neck pain.
Received in revised form 13 May 2008 Twenty patients (mean age 64.5 years) completed a patient-specific questionnaire, the Problem Elic-
Accepted 27 July 2008
itation Technique (PET), followed by the NDI and NPAD. Content validity was assessed by comparing the
items of the NDI and NPAD with problems identified from the PET. Construct validity of the fixed-item
Keywords: questionnaires was examined by establishing the correlation with each other, and with the PET score.
Neck pain
Eleven common problems were identified by patients through the PET, of which six were included in the
Disability
NDI and seven included in the NPAD. The NDI and NPAD scores were strongly correlated ( r 0.86,
Outcome assessment
Questionnaires p < 0.01), while the correlation between the PET and the fixed-item questionnaires was moderate (NDI:
r 0.62, p < 0.01; NPAD: r 0.71, p < 0.01). Both the NDI and the NPAD include most of the functional
problems common to this patient group, and display good content validity. The PET is better able to
evaluate the problems specific to the individual patient and is therefore measuring a somewhat different
construct to the fixed-item questionnaires.
2007 Elsevier Ltd. All rights reserved.

1. Introduction function (Pietrobon et al., 2002). In relation to neck pain, this

Neck pain has a lifetime prevalence of about 70% in the general
population (Makela et al., 1991; Bovim et al., 1994). Although acute
neck pain often resolves, about 19% of the population may suffer
from chronic neck pain at any given time (Bovim et al., 1994; Guez
et al., 2002). Measurement of the impact of neck pain on the
sufferer presents a challenge due to the variability between
patients in pain intensity, and the effect of the disorder on physical
and psychological functions (Clair et al., 2004). Measures of pain
intensity and tissue sensitivity have been used to quantify the
sensory dimension of neck pain disorders (Hubka and Phelan,1994;
Olson et al., 2000), while range of motion and muscle function has
been used to measure impairments of physical function (Falla et al.,
2004; Jull et al., 2004; Hoving et al., 2005; OLeary et al., 2007).
However, recent recommendations place greater emphasis on
functional status and quality of life more broadly, in the evaluation
of neck pain disorders (Philadelphia Panel, 2001; Pietrobon et al.,
2002).
Measurement of function has been a developing theme in neck
pain research as this shifts the focus away from signs and symp-
toms towards the specific effects of the symptoms on patient
* Corresponding author. Tel.: 61 8 9266 3665; fax: 61 8 9266 3699.
E-mail address: s.edmondston@curtin.edu.au (S.J. Edmondston).
includes neck function, physical function more generally, and
psychological function. A range of neck pain-specific questionnaires
have been developed for this purpose, and have been incorporated
into recent clinical studies (Vernon and Mior,1991; Leak et al.,1994;
Jordan et al., 1998; Westaway et al., 1998; Wheeler et al., 1999). The
value of questionnaires is dependent on a range of factors but of
primary importance is the validity, particularly in relation to
construct and content. A recent review of neck pain-specific
questionnaires concluded that most have not been extensively
validated, and recommended a comparative study to better define
the psychometric properties of the commonly used instruments
(Pietrobon et al., 2002).
The Neck Disability Index (NDI) is the most commonly used
questionnaire for the measurement of neck pain disability. It was
originally developed to evaluate the activities of daily living in
patients with disabling neck pain, particularly that resulting from
whiplash trauma (Vernon and Mior, 1991). The NDI includes 10
questions of which 7 examine functional activities, 2 ask about
symptoms and the final question considers concentration. The Neck
Pain and Disability Scale (NPAD) was developed to provide clini-
cians with a tool to assess the multi-dimensional effects of the neck
pain disorder (Wheeler et al., 1999). The scale consists of 20 ques-
tions relating to 4 domains (neck function, pain intensity, emotion/
cognition and activities of daily living) which look at the effects of

1356-689X/$ - see front matter 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2008.07.005
Please cite this article in press as: Chan Ci En M et al., Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring
disability associated with chronic, non-traumatic neck pain, Manual Therapy (2008), doi:10.1016/j.math.2008.07.005
 ARTICLE IN PRESS
2 M. Chan Ci En et al. / Manual Therapy xxx (2008) 1-6
the neck pain disorder on patients physical and emotional func-
tions. The potential limitation of these questionnaires, and others
with fixed questions, is that they constrain the scope of the eval-
uation to the specific issues included. Therefore, the questionnaire
may include questions not relevant to some patients, and may not
include issues of importance.
An alternative to the fixed-item questionnaire are the patient-
specific techniques which require patients to generate their own,
possibly unique, set of problems or items. The patient-specific
methods offer the advantage of identifying the problems or issues
relevant to each individual, and are therefore consistent with the
approach to patient evaluation commonly employed in clinical
practice (Jolles et al., 2005). Two patient-specific techniques which
have been used to evaluate neck pain are the Problem Elicitation
Technique (PET) and the Patient-Specific Functional Scale (PSFS)
(Buchbinder et al., 1995; Westaway et al., 1998). The disadvantage
of this approach, particularly in research, is that without stand-
ardisation of content, the scale is different for each patient (Jolles
et al., 2005). The level of statistical correlation between patient-
specific scales and fixed-item questionnaires has been found to be
only moderate (Westaway et al., 1998; Hoving et al., 2003).
Clinical studies in which multiple neck pain questionnaires are
applied simultaneously in the same patient population have been
identified as an important focus for research in this area ( Pietrobon
et al., 2002). Specifically, patient-specific questionnaires will help
identifying the problems which are most common and relevant to
specific sub-groups of patients with neck pain. This may assist the
development or modification of fixed-item questionnaires, and
enhance the psychometric evaluation, particularly the content and
construct validity. Hoving et al. (2003) used the PET to evaluate the
validity of the NDI and Northwick Park Neck Pain questionnaire in
patients with neck pain associated with whiplash injury. They
found that the two fixed-item questionnaires did not fully cover the
problems considered important in patients with whiplash injury,
especially those concerning emotional and social functions. More
recently, the NDI has been shown to have poor construct validity
and to be less responsive to change than the PSFS, in patients with
cervical radiculopathy (Cleland et al., 2006). Further, the NDI has
been shown to be less responsive to change than previously
reported in patients with non-traumatic neck pain (Cleland et al.,
2008). These findings suggest that analysis of the psychometric
properties of the NDI and other fixed-item questionnaires in
different groups of patients with neck pain should be an on-going
process.
To date there has been little evaluation of the common problems
associated with chronic, non-traumatic neck pain, particularly in
older patients. Recent studies of this patient group have examined
patient variability and treatment dose (Clair et al., 2004; Clair et al.,
2006), but an evaluation of the common functional problems and
validity of fixed-item questionnaires has not been conducted. The
purpose of this study was to examine the content and construct
validity of two fixed-item questionnaires as measures of disability
in patients with chronic, non-traumatic neck pain. This was ach-
ieved through a comparison of the NDI and NAPD questionnaires in
a cohort of patients with this disorder, and comparison of the
responses to the fixed-item questionnaires with a patient-specific
questionnaire, the PET.
2. Methods
2.1. Study population
A cross-sectional survey of 20 subjects with chronic, non-trau-
matic neck pain was performed. Subjects were recruited from two
public hospitals in Perth, Western Australia. Nineteen subjects were
referred to the physiotherapy department for treatment of chronic,
non-traumatic neck pain. The remaining subject was a physiother-
apist who had a long-standing history of non-traumatic neck pain.
All subjects had a current episode of neck pain of greater than three
months duration, with pain predominantly located in the somatic
referral zones of the cervical spine (Grubb and Kelly, 2000).
Participants were excluded if the symptom duration did not exceed
three months, or were unable to read or comprehend the ques-
tionnaires. Subjects with a specific diagnosis such as cervical rad-
iculopathy, ankylosing spondylitis and rheumatoid arthritis, or who
had a history of neck trauma were not included in the study. The
institutional Human Research Ethics Committee granted approval
for this study.
2.2. Procedure
Upon consenting to be involved in the study, participants were
asked general questions in relation to age, symptom duration,
current medication intake, and average pain intensity over the
previous week. The average pain intensity was measured using
a 10 cm visual analogue scale (VAS). The PET was firstly performed
for all subjects, and was administered by a skilled interviewer. After
PET, all participants completed the NDI and NPAD in a random
order.
2.3. Patient questionnaires
The PET is a disability questionnaire designed to help clinicians
to identify the most significant problems experienced by each
individual patient (Bakker et al., 1995; Buchbinder et al., 1995). A
skilled interviewer carries out the interview where subjects are
allowed to spontaneously identify problems associated with their
neck pain disorder. The interviewer then assists the subject with
a series of open-ended questions, which cover areas such as self-
care and work, mobility, leisure activities, social activities, emotion,
communication and sleep. Subjects are allowed to identify
a maximum of 15 problems. The subject is then asked to rate the
severity of each problem on an 11-point numerical scale (no
severity 0 to extremely severe 10). Finally, the subject ranks the
problems according to their importance, from the most to least
significant. In this study, the overall PET score was defined as the
sum of the severity scores for all problems divided by the number of
problems identified. The PET score had a possible range between
0 and 10.
The NDI is a 10-item questionnaire which asks patients about
their symptoms and the effect of their neck pain on a range of
functional activities (Vernon and Mior, 1991). The items in the
questionnaire are pain intensity, personal care, lifting, reading,
headache, concentration, work, driving, sleeping and recreation.
The subject is instructed to circle one of the six options which
describes the severity of each item (0-5). The NDI score is calcu-
lated as the sum of the scores for each question multiplied by two
(range 0-100). A higher score is indicative of greater disability
associated with the neck disorder (Vernon and Mior, 1991).
The NPAD is a 20-item questionnaire which examines the effects
of the neck pain disorder and covers four factors of neck function,
pain intensity, cognitive and emotional affects and activities of daily
living (Wheeler et al., 1999). The subject responds to each question
on a 10 cm visual analogue scale where the subject indicates the
severity or frequency of each item. Each question was measured
using a ruler to provide each individual score. The total NPAD score
is the sum of the scores of all 20 questions divided by 2, where the
maximum score is 100 and the minimum is 0. Like the NDI, a higher
score will indicate greater disability. The NPAD has the potential
advantage as the four factors examine the various aspects of the
effects of the neck pain disorder on patients physical, cognitive or
emotional function (Goolkasian et al., 2002; Clair et al., 2004).
Please cite this article in press as: Chan Ci En M et al., Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring
disability associated with chronic, non-traumatic neck pain, Manual Therapy (2008), doi:10.1016/j.math.2008.07.005
 ARTICLE IN PRESS

M. Chan Ci En et al. / Manual Therapy xxx (2008) 1-6 3

2.4. Statistical analyses Table 2

Disability profile of the study population according to the PET dimensions

The content validity of the NDI and NPAD was studied by

Number of patients Overall number Number of Mean
comparing the items in the questionnaires with the problems who identified of problems different severity per
identified by the PET. The frequency of each problem and ranking problems within identified in problems dimension
by importance were determined. each dimension (%) each within each (possible
The construct validity of the NDI and NPAD was examined by dimension dimension range 0-10)

determining the association between the questionnaire scores and Role activity 17 (85.0) 53 12 6.8
Emotional 15 (75.0) 19 4 7.1
the PET score, using Pearsons correlation coefficients. The corre-
Sleep 18 (90.0) 23 2 7.1
lation between the NDI and NPAD scores was also examined. Mobility 18 (90.0) 30 5 6.8
Sport and 6 (30.0) 6 1 6.5
3. Results leisure
Social activity 10 (50.0) 10 3 6.9
Personal care 8 (40.0) 10 2 6.5
Twenty subjects (7 males, 13 females) with a mean age of 64.5 Communication 10 (50.0) 11 3 6.9
years (SD 12.8) were recruited over a three-month period. The Symptoms 15 (75.0) 19 3 7.4
mean symptom duration was 115.6 months (SD 119.5). The Table shows the number of problems, the number of patients who identified
characteristics of the study population are summarised in Table 1. problems within each dimension, and the mean severity of problems per dimension.
The average pain intensity over the week prior to the interview was
5.2 (SD 1.9). The mean NDI and NPAD scores were 33.1 (SD 17.2)
and 47.7 (SD 23.7), respectively. The mean PET score was 6.6 severity scores were found in depression (9.3), cooking (8.3), and
(SD 1.7). The PET identified an average of 9.2 problems per patient sitting upright (8.0). The individual problems that were ranked
(SD 3.7). most important by the subjects were driving (30.0%), sleep
disturbance (30.0%) and frustration (20.0%). Of the 11 problems
3.1. Content validity identified by most subjects, 6 of these are included in the NDI and 7 are
included in the NPAD (Table 4).
Table 2 presents the disability profile of the study population
according to the PET dimensions. Over 80% of the patients identi- 3.2. Construct validity
fied one or more problems within the dimensions of sleep (90.0%),
mobility (90.0%) and role activity (85.0%). There were 23, 30 and 53 The PET was moderately correlated with the NDI (r 0.62,
individual problems identified within these three dimensions, p < 0.01) and NPAD (r 0.71, p < 0.01). There was a stronger
respectively. More than half of the subjects identified problems correlation between the NDI and NPAD (r 0.86, p < 0.01). The
within the dimensions of emotion (75.0%) and symptoms (75.0%).
The individual patient problems identified by the PET and their Table 3
mean severity are presented in Table 3. Only problems identified by Problems identified by patients using the PET, and the mean severity and ranking of
two or more patients are presented. Of the individual problems importance
identified by the PET, sleep disturbance had the highest prevalence Dimension Problem Number Mean Number of
(75.0%). More than half of the subjects identified frustration of subjects (SD) subjects
(%) severity ranking problem
(65.0%), driving (60.0%) and lifting (60.0%). Other common prob-
(0-10) as most important
lems (more than 33%) were looking into cupboards (45.0%), (%)
gardening (40.0%), headaches (40.0%), housework (35.0%), working Role Activity Looking into cupboards 9 (45) 5.3 0 (0)
overhead (35.0%), and general exercise (35.0%). The highest mean Gardening 8 (40) 6.6 0
Housework 7 (35) 7.7 3 (15)
Working overhead 7 (35) 6.6 0
Table 1 Hanging up washing 6 (30) 7.8 2 (10)
Demographic and clinical characteristics of the study population (n 20) Work for wages 4 (20) 6.5 3 (15)
Age (years) Vacuuming 4 (20) 7.0 1 (5)
Mean 64.5 Cooking 4 (20) 8.3 1 (5)
SD 12.8 Emotional Frustration 13 (65) 6.5 4 (25)
Range 22.0-83.0 Depression 4 (20) 9.3 0
Gender (%) Sleep Affected sleep 15 (75) 7.1 6 (30)
Male 7 (35.0) Fatigue throughout day 8 (40) 7.1 0
Female 13 (65.0)
Mobility Driving 12 (60) 6.2 6 (30)
Symptom duration (%) Lifting 12 (60) 7.6 2 (10)
3-6 months 3 (15.0) Crossing the road 3 (15) 7.0 1 (5)
6-12 months 1 (5.0)
12-24 months 3 (15.0) Social Socialising with friends 6 (30) 6.5 0
>24 months 13 (65.0) Activities

Medication (%) Sports and General exercise 7 (35) 7.3 0

None 4 (20.0) leisure Non athletic leisure 2 (10) 7.0 0
Analgesics only 6 (30.0) activities
Analgesics and NSAIDS 9 (45.0) Personal Care Dressing 6 (30) 6.0 2 (10)
Anti-depressants 1 (5.0) Hair care 4 (20) 7.3 0
Outcome measures [mean (SD)] Communication Computer use 6 (30) 6.3 1 (5)
Average pain intensity over past week 5.2 (1.9) Reading 4 (20) 7.3 1 (5)
NDI percentage score (0-100) 33.1 (17.2)
NPAD percentage score (0-100) 47.7 (23.7) Symptoms Headaches 8 (40) 7.6 2 (10)
Overall PET score (0-10) 6.6 (1.7) Concentration 6 (30) 7.8 1 (5)
Mean number of problems elicited 9.2 (3.7) Neck movements 5 (25) 6.6 0
Please cite this article in press as: Chan Ci En M et al., Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring
disability associated with chronic, non-traumatic neck pain, Manual Therapy (2008), doi:10.1016/j.math.2008.07.005
 ARTICLE IN PRESS

4 M. Chan Ci En et al. / Manual Therapy xxx (2008) 1-6

Table 4 construction of the NDI and NPAD, some questionnaires have been
Comparison of commonly identified problems elicited by the PET with items in NDI developed with little or no input from patients with neck pain
and NPAD
(Pietrobon et al., 2002). Establishing the validity of a questionnaire is
Identified problem Item included in NDI Item included in NPAD important to ensure that it reflects the nature and spectrum of the
Affected sleep Yes Yes problems experienced by the majority of patients. The validity of the
Frustration Yes NDI and NPAD has been investigated in patients with
Driving Yes Yes
whiplash-related neck pain (Goolkasian et al., 2002; Hoving et al.,
Lifting Yes
Looking into cupboards Yes 2003), but this is the first study to specifically examine the validity of
Gardening two commonly used disability questionnaires in an older cohort of
Headaches Yes patients with chronic, non-traumatic neck pain.
Fatigue throughout day The PET simulates clinical practice by asking patients to identify
Housework Yes Yes
Working overhead Yes
physical, emotional and cognitive problems specific to their neck
pain disorder. It serves to elicit the problems specific to each
patient, thereby reducing the noise created when items not rele-
association between the three questionnaires is presented graphi- vant to the patient are included (Buchbinder et al., 1995; Jolles et al.,
cally in Fig. 1. 2005). The most commonly reported functional problems in the
present study were disturbed sleep, driving, and lifting, while
4. Discussion frustration was the most common emotional problem. In patients
with whiplash, who were significantly younger than the patients in
In the development of neck pain questionnaires, assumptions the current study, the most common functional problems identified
were made as to the nature of the functional limitations associated were work for wages, fatigue during the day, participation in sports,
with neck pain. However, patient input is considered paramount in and driving, while the most common emotional problem was
the development and evaluation of an outcome measure (Guyatt depression (Hoving et al., 2003). Driving or riding in a car was the
et al., 1993). While there was some input from patients in the only common functional problem experienced by both patient

80 100
r = 0.86 r = 0.71

80
60

60

40

40

20
20

0 0
0 20 40 60 80 100 3 4 5 6 7 8 9
NPAD Score PET Score

80
r = 0.62

60

40

20

0
3 4 5 6 7 8 9
PET Score
 Fig. 1. Scatter plots showing the relationships between total scores for the NDI, NPAD and PET questionnaires.

Please cite this article in press as: Chan Ci En M et al., Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring
disability associated with chronic, non-traumatic neck pain, Manual Therapy (2008), doi:10.1016/j.math.2008.07.005

NPAD Score
NDI Score

NDI Score
 ARTICLE IN PRESS
M. Chan Ci En et al. / Manual Therapy xxx (2008) 1-6
groups. This finding suggests that the impact of neck pain on
physical and emotional functions may be somewhat different in
older patients with non-traumatic neck pain compared to younger
patients who have whiplash-related neck pain. This is consistent
with the studies which have reported differences in the nature and
severity of physical impairments in patients with neck pain of
traumatic origin, compared to those with a non-traumatic onset
(Dumas et al., 2001; Drottning et al., 2002).
Of the 10 most common problems identified by the PET, 6 were
included in the NDI and 7 were included in the NPAD, which
supports the content validity of both questionnaires for this patient
population. Sleep disturbance, driving and frustration were ranked
as the three most commonly reported problems. All are included in
the NPAD, while frustration is not addressed in the NDI. A significant
impact on psychological function has been described in patients with
chronic, non-traumatic neck pain, which was found to improve with
improvements in pain intensity and functional limitation (Clair et al.,
2006). The NPAD differs from the NDI in that it includes questions
which relate specifically to emotion and social function. The NPAD
uses sub-domains to identify more specifically the areas of physical
and psychological functions most commonly indicated by the
patient as being affected. While most of the common functional
problems relevant to this patient group are included in the NDI and
NPAD, the greater scope of the latter questionnaire may provide
better information about the impact of the disorder on the patient
more broadly. The results of the present study suggest that neck pain
questionnaires should have a greater emphasis on neck function,
activities of daily living and psychological function, and limited
emphasis on symptoms such as pain intensity, tissue tenderness and
movement restrictions which can be measured in other ways.
The high correlation between the NDI and NPAD scores suggests
that they measure the same construct in this patient group. While
the questionnaire format and scoring systems are different, the
questionnaires address a range of common items, which relate to
function rather than symptoms. Previous studies have shown high
correlation between the NDI and other fixed-item neck pain
questionnaires, where the items in the questionnaires were very
similar (Hoving et al., 2003; Wlodyka-Demaille et al., 2004; Gay
et al., 2007). The only previous study to directly compare the NDI
and NPAD found a moderate correlation (r 0.72) between ques-
tionnaires, in younger patients with neck pain of both traumatic
and atraumatic origins (Goolkasian et al., 2002).
Consistent with the study of Hoving et al. (2003), there was
a moderate correlation between the PET and both fixed-item
questionnaires, which suggests that the PET measures a somewhat
different construct. This may be due to the PET only scoring items of
relevance to each patient. For this reason, the PET reflects clinical
practice as it identifies problems relevant to the individual, which
may include issues not addressed in fixed-item questionnaires. A
recommendation based on the results of the present study is that
the PET should be used in conjunction with a fixed-item ques-
tionnaire, as each provides different information about the study
population. While fixed-item questionnaires are relatively simple
to administer, the PET requires some training and experience of the
interviewer to ensure consistency in its application and adherence
to the target concept (Jolles et al., 2005).
During the study the relevance of the driving item in the NDI
was raised by some patients, as many of the subjects did not drive,
either due to their age or the neck pain disorder. The applicability of
the driving item in the NDI to non-drivers has not previously been
considered and may be an area for review. Previous studies have
chosen to modify the NDI in an attempt to improve the relevance of
the questionnaire to the specific study population (Hains, 1998;
Riddle and Stratford, 1998). In the present study, the item was
answered by either a driver or a passenger, consistent with the
driving question in the NPAD. This modification to the NDI should
5
be considered if the questionnaire is used in future studies with this
patient group.
A potential limitation of this study is the relatively small study
population. However, the characteristics of the patients were
consistent with those of larger studies of patients with chronic,
non-traumatic neck pain (Clair et al., 2004, 2006). The higher
proportion of women in this study (65%) is consistent with gender
ratios in other neck pain studies where the proportion of female
subjects has been between 60 and 70% (Guez et al., 2003; Clair
et al., 2004; Gay et al., 2007). The age and symptom duration
suggest that degenerative pathology and the effects of aging may be
important in the development of the symptoms, however, a review
of radiological examinations and correlation with symptoms were
not part of the present study. The patients in the study were
receiving treatment in a public health system, and the problems
identified may not reflect those of all patients with non-traumatic
neck pain in the broader community.
In conclusion, the NDI and NPAD both identified the common
problems considered important by the patients, and the NPAD
included all problems ranked as most important. Both question-
naires have good content validity and are therefore equally relevant
for use in this patient group. The broader scope of the NPAD,
particularly in relation to emotional and social functions, may be an
advantage in future studies. In future research involving chronic,
non-traumatic neck pain, it is recommended that a patient-specific
questionnaire such as the PET should be used in conjunction with
a fixed-item neck pain questionnaire, as each seems to measure
a somewhat different construct.
Acknowledgements
The authors acknowledge the support of the staff of the Phys-
iotherapy Outpatient Department, Osborne Park Hospital, Perth,
Western Australia, for their assistance in recruitment of subjects for
this study.
References
Bakker C, van der Linden S, van Santen-Hoeufft M, Bolwijn P, Hidding A. Problem
elicitation to assess patient priorities in ankylosing spondylitis and fibro-
myalgia. Journal of Rheumatology 1995;22:1304-10.
Bovim G, Schrader H, Sand T. Neck pain in the general population. Spine
1994;19:1307-9.
Buchbinder R, Bombardier C, Yeung M, Tugwell P. Which outcome measures should
be used in rheumatoid arthritis clinical trials? Arthritis & Rheumatism
1995;38:1568-80.
Clair D, Edmondston S, Allison G. Variability in pain intensity, physical and
psychological function in non-acute, non-traumatic neck pain. Physiotherapy
Research International 2004;9:43-54.
Clair DA, Edmondston SJ, Allison GT. Physical therapy treatment dose for non-
traumatic neck pain: a comparison between 2 patient groups. Journal of
Orthopaedic and Sports Physical Therapy 2006;36:867-75.
Cleland JA, Childs JD, Whitman JM. Psychometric properties of the neck disability
index and numeric pain rating scale in patients with mechanical neck pain.
Archives of Physical Medicine and Rehabilitation 2008;89:69-74.
Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and construct validity of
the neck disability index and patient specific functional scale in patients with
cervical radiculopathy. Spine 2006;31:598-602.
Drottning M, Staff PH, Sjaastad O. Cervicogenic headache (CEH) after whiplash
injury. Cephalalgia 2002;22:165-71.
Dumas J-P, Arsenault AB, Boudreau G, Magnoux E, Lepage Y, Bellavance A, Loisel P.
Physical impairments in cervicogenic headache: traumatic vs. non-traumatic
onset. Cephalalgia 2001;21:884-93.
Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered
patterns of muscle activation during performance of a functional upper limb
task. Spine 2004;29:1436-40.
Gay RE, Madson TJ, Cieslak KR. Comparison of the neck disability index and the
Bournemouth neck questionnaire in a sample of patients with chronic
uncomplicated neck pain. Journal of Manipulative and Physiological Thera-
peutics 2007;30:259-62.
Goolkasian P, Wheeler AH, Gretz SS. The neck pain and disability scale: test-retest
reliability and construct validity. Clinical Journal of Pain 2002;18:245-50.
Grubb SA, Kelly CK. Cervical discography: clinical implications from 12 years of
experience. Spine 2000;25:1382-9.
Please cite this article in press as: Chan Ci En M et al., Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring
disability associated with chronic, non-traumatic neck pain, Manual Therapy (2008), doi:10.1016/j.math.2008.07.005
 ARTICLE IN PRESS
6 M. Chan Ci En et al. / Manual Therapy xxx (2008) 1-6
Guez M, Hildingsson C, Nilsson M, Toolanen G. The prevalence of neck pain. Acta
Orthopaedica Scandinavica 2002;73:455-9.
Guez M, Hildingsson C, Stegmayr B, Toolanen G. Chronic neck pain of traumatic and
non-traumatic origin. Acta Orthopaedica Scandinavica 2003;74:576-9.
Guyatt G, Feeney DH, Patrick DL. Measuring health-related quality of life. Annals of
Internal Medicine 1993;118:622-9.
Hains F. Psychometric properties of the neck disability index. Journal of Manipu-
lative and Physiological Therapeutics 1998;21:75-80.
Hoving JL, OLeary EF, Niere KR, Green S, Buchbinder R. Validity of the neck
disability index, Northwick Park neck pain questionnaire, and problem elici-
tation technique for measuring disability associated with whiplash-associated
disorders. Pain 2003;102:273-81.
Hoving JL, Pool JJ, van Mameren H, Deville WJ, Assendelft WJ, de Vet HC, de
Winter AF, Koes BW, Bouter LM. Reproducibility of cervical range of motion in
patients with neck pain. BMC Musculoskeletal Disorders 2005;6:59-67.
Hubka MJ, Phelan SP. Inter-examiner reliability of palpation for cervical spine
tenderness. Journal of Manipulative and Physiological Therapeutics
1994;17:591-5.
Jolles BM, Buchbinder R, Beaton DE. A study compared nine patient-specific indices for
musculoskeletal disorders. Journal of Clinical Epidemiology 2005;58:791-801.
Jordan A, Manniche C, Mosdal C, Hindsberger C. The Copenhagen neck functional
disability scale: a study of reliability and validity. Journal of Manipulative and
Physiological Therapeutics 1998;21:520-7.
Jull G, Kristjansson E, DallAlba P. Impairment in the cervical flexors: a comparison
of whiplash and insidious onset neck pain patients. Manual Therapy
2004;9:89-94.
Leak AM, Cooper J, Dyer S, Williams KA, Turner-Stokes L, Frank AO. The Northwick
Park neck pain questionnaire, devised to measure neck pain and disability.
British Journal of Rheumatology 1994;33:469-74.
Makela M, Heliovarra M, Sievers K, Impivaara O, Knekt P, Aromaa A. Prevalence,
determinants, and consequences of chronic pain in Finland. American Journal of
Epidemiology 1991;124:1356-67.
OLeary S, Jull G, Kim M. Vicenzino B Cranio-cervical flexor muscle impairment at
maximal, moderate, and low loads is a feature of neck pain. Manual Therapy
2007;12:34-9.
Olson SL, OConnor DP, Birmingham G, Broman P, Herrera L. Tender point sensitivity,
range of motion and perceived disability in subjects with neck pain. Journal of
Orthopaedic and Sports Physical Therapy 2000;30:13-20.
Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines
on selected rehabilitation interventions for neck pain. Physical Therapy
2001;81:1701-17.
Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for
measurement of functional outcome for cervical pain or dysfunction. Spine
2002;27:515-22.
Riddle DL, Stratford PW. Use of generic versus region-specific functional status
measures on patients with cervical spine disorders. Physical Therapy
1998;79:951-63.
Vernon H, Mior S. The neck disability index: a study of reliability and validity.
Journal of Manipulative and Physiological Therapeutics 1991;14:409-15.
Westaway MD, Stratford PW, Binkley JM. The patient-specific functional scale:
validation of its use in persons with neck dysfunction. Journal of Orthopaedic and
Sports Physical Therapy 1998;27:331-8.
Wheeler AH, Goolkasian P, Baird AC, Darden BV. Development of the neck pain and
disability scale: item analysis, face, and criterion-related validity. Spine
1999;24:1290.
Wlodyka-Demaille S, Poiraudeau S, Catanzariti J-F, Rannou F, Fermanian J, Revel M.
The ability to change of three questionnaires for neck pain. Joint Bone Spine
2004;71:317-26.
Please cite this article in press as: Chan Ci En M et al., Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring
disability associated with chronic, non-traumatic neck pain, Manual Therapy (2008), doi:10.1016/j.math.2008.07.005