NECK DISABILITY INDEX

Full Name *

Date *

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 enter the value in the box next to the statement that applies to you. We realize you may consider that two or more statements in any one section relate to you, but please just enter the value in the box next to the statement that most closely describes your problem.

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Section 1 – Pain intensity *

0. I have no pain at the moment

1. The pain is very mild at the moment

2. The pain is moderate at the moment

3. The pain is fairly severe at the moment

4. The pain is very severe at the moment

5. The pain is the worst imaginable at the moment

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Section 2 – Personal care (washing, dressing etc) *

0. I can look after myself normally without causing extra pain

1. I can look after myself normally but it causes extra pain

2. The pain is fairly severe at the moment

3. I need some help but manage most of my personal care

4. I need help every day in most aspects of self-care

5. I do not get dressed, I wash with difficulty and stay in bed

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Section 3 – Lifting *

0. I can lift heavy weights without extra pain

1. I can lift heavy weights but it gives extra pain

2. Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently placed eg. on a table

3. Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

4. I can lift very light weights

5. I cannot lift or carry anything at all

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Section 4 - Reading *

0. I can read as much as I want with no neck pain.

1. I can read as much as I want with minimal pain in my neck

2. I can read as much as I want with moderate pain in my neck

3. I don't read as much as I want because of moderate pain in my neck

4. I can't read at all because of severe pain in my neck

5. I do not read because of the pain it causes.

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Section 5 - Headaches *

0. I have no headaches at all.

1. I have slight headaches, which come infrequently

2. I have moderate headaches, which come infrequently

3. I have moderate headaches, which come frequently

4. I have severe headaches, which come frequently

5. I have headaches almost all the time

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Section 6 - Concentration *

0. I can concentrate fully when I want to with no difficulty

1. I can concentrate fully when I want to with slight difficulty

2. I have a fair degree of difficulty in concentrating when I want to

3. I have a lot of difficulty in concentrating when I want to

4. I can hardly concentrate at all because of severe pain in my neck

5. I cannot concentrate at all

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Section 7 - Work *

0. I can do as much work as I want to

1. I can only do my usual work, but no more

2. I can do most of my usual work, but no more

3. I cannot do my usual work

4. I can hardly do any work at all

5. I can’t do any work at all

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Section 8 - Driving *

0. I can drive my car without any neck pain

1. I can drive my car as long as I want with slight pain in my neck

2. I can drive my car as long as I want with moderate pain in my neck

3. I can’t drive my car as long as I want because of moderate pain in my neck

4. I can hardly drive at all because of severe pain in my neck

5. I can’t drive my car at all

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Section 9 - Sleeping *

0. I have no trouble sleeping

1. My sleep is slightly disturbed (less than 1 hr sleepless)

2. My sleep is mildly disturbed (1-2 hrs sleepless)

3. My sleep is moderately disturbed (2-3 hrs sleepless)

4. My sleep is greatly disturbed (3-5 hrs sleepless)

5. My sleep is completely disturbed (5-7 hrs sleepless)

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Section 10 - Recreation *

0. I am able to engage in all my recreation activities with no neck pain at all

1. I am able to engage in all my recreation activities, with some pain in my neck

2. I am able to engage in most, but not all of my usual recreation activities because of pain in my neck

3. I am able to engage in a few of my usual recreation activities because of pain in my neck

4. I can hardly do any recreation activities because of pain in my neck

5. I can’t do any recreation activities at all

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Copyright: Vernon H. and Hagino C., 1987. Vernon H, Mior S. The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics 1991; 14:409-415. Copied with permission of the authors