Impact of Racial/Ethnic Disparities on Patient-Reported Outcomes Following Cervical Spine Surgery: QOD Analysis.

STUDY DESIGN: Retrospective analysis of data from the cervical module of a National Spine Registry, the Quality Outcomes Database. OBJECTIVE: To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at one year after cervical spine surgery. SUMMARY OF BACKGROUND DATA: Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and a prolonged length of stay after cervical spine surgery compared with Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic, and other non-Hispanic groups ( i.e . Asian) remains unclear. MATERIALS AND METHODS: PROMs were used to assess disability (neck disability index) and neck/arm pain preoperatively and one-year postoperative. Primary outcomes were disability and pain, and not being satisfied from preoperative to 12 months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups [Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)] with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving a minimal clinically important difference one-year postoperatively. RESULTS: On average, the sample of 14,429 participants had significant reductions in pain and disability, and 87% were satisfied at one-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30%-70%) compared with NHW. NHB had 50% higher odds of worse disability scores compared with NHW. NHA reported similar disability and neck pain outcomes compared with NHW. CONCLUSIONS: Hispanic and NHB patients had worse patient-reported outcomes one year after cervical spine surgery compared with NHW individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for NHA patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery.

Validation of the Nepali versions of the Neck Disability Index and the Numerical Rating Scale for Neck Pain.

STUDY DESIGN: A cross-sectional study with a test-retest design. OBJECTIVE: To translate and culturally adapt the numerical rating scale (NRS) for neck pain intensity and the Neck Disability Index (NDI), and asses their measurement properties in a Nepalese neck pain population. SUMMARY OF BACKGROUND DATA: Neck pain is one of the most common musculoskeletal disorders in Nepal. Research on neck pain disorders has been hampered by lack of standardized patient-reported outcome measures (PROMs) in Nepali language. Therefore, we aimed at validating a Nepali version of the NDI and NRS neck pain. METHODS: At Dhulikhel hospital in Nepal, 150 patients with neck pain and/or cervical radiculopathy completed the translated self-administered questionnaires. We had made one cultural adaption of the NDI driving item in the final Nepali version. Relative reliability was analyzed with intraclass correlation coefficient (ICC 2.1) and absolute reliability with the smallest detectable change (SDC). Internal consistency was assessed by Cronbach alpha. Construct and discriminative validity was assessed by Spearman correlation for a priori hypotheses, receiver-operating characteristics curves, and analysis of variance. Time spent and assistance needed to complete the questionnaires were used to assess feasibility. RESULTS: Test-restest reliability was excellent with ICC (95% confidence intervals) of 0.87 (0.66, 0.94) for NDI and 0.97 (0.94, 0.99) for NRS neck pain. The absolute reliability was acceptable (a SDC of 1.6 for NRS and 9.3 for NDI) and a Cronbach alpha (internal consistency) of 0.70 for NDI, as well as acceptable construct validity, discriminative validity, and feasibility. CONCLUSION: The Nepali versions of the NRS neck pain and NDI can be recommended for assessing pain and disability among patients with neck pain and cervical radiculopathy, but their responsiveness to change remains to be tested.Level of Evidence: 2.

Cross-cultural Adaptation, Reliability, Validity, and Responsiveness of the Simplified-Chinese Version of Neck Disability Index.

STUDY DESIGN: Cross-cultural adaptation and psychometric evaluation. OBJECTIVE: The aim of this study was to translate the Neck Disability Index (NDI) into the simplified-Chinese language and to evaluate the reliability, validity, and responsiveness of the new questionnaire. SUMMARY OF BACKGROUND DATA: Neck pain is a major health problem resulting in major disability. NDI is the most frequently used scale for self-rating of disability due to neck pain. At present, there is no simplified-Chinese version of the NDI. The aims of this study were to culturally adapt and translate the NDI into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties in patients with neck pain. METHODS: The NDI was translated into simplified-Chinese version based on established guidelines. A total of 70 patients participated in this study. Patients were asked to complete a set of questionnaires comprising of their demographic information, the NDI-SC, and a visual analog scale (VAS) of pain. Fifty-six patients returned after 1 to 2 weeks to complete the same set of questionnaires and the global rating of change (GROC) scale. Then, the NDI-SC was evaluated for content validity, construct validity, internal consistency, test-retest reliability, and responsiveness. RESULTS: The NDI-SC demonstrated excellent internal consistency (Cronbach α = 0.92) and good test-retest reliability (ICC2,1 = 0.85). Content validity was confirmed as no floor or ceiling effects were detected for the NDI-SC total score. Construct validity was established with factor analysis revealing two-factor subscales explaining 66% of the variance. The NDI-SC showed a strong correlation with VAS (Rp = 0.61, P < 0.001) and a moderate correlation with GROC (Rs = 0.46, P < 0.001). The correlation between NDI-SC change scores and VAS change scores was also moderate (Rp = 0.59, P < 0.001). CONCLUSION: The results showed that the NDI-SC is a reliable, valid, and responsive instrument to measure functional limitations in patients with neck pain. LEVEL OF EVIDENCE: 3.

Development, validity and reliability of the Italian version of the Copenhagen neck functional disability scale.

BACKGROUND: Valid and reliable patient-reported outcome measures support health professionals in evaluating the results of clinical research and practice. The Copenhagen Neck Functional Disability Scale (CNFDS) has shown promising measurement properties to measure disability in patients with neck pain, but an Italian version of this questionnaire is not available. The objective of this study was to cross-culturally adapt the CNFDS into Italian (CNFDS-I), and to assess its validity and reliability in patients with neck pain. METHODS: The CNFDS-I was developed according to well-established guidelines for cross-cultural adaptation of patient-reported outcome measures. A cross-sectional clinimetric study was conducted to evaluate its validity and reliability. Patients with chronic neck pain (pain > 3 months) participated in this study. The following measurement properties (defined by the COSMIN initiative) were assessed: structural validity (exploratory factor analysis), internal consistency (Cronbach's α), construct validity [by testing hypotheses on expected correlations with the Neck Disability Index (NDI), the Neck Bournemouth Questionnaire (NBQ), and pain Visual Analogue Scale (VAS)]. Test-retest reliability [Intraclass Correlation Coefficient for agreement (ICCagreement)], and measurement error [Smallest Detectable Change (SDC)] were also assessed in 50 clinically stable patients. Floor/ceiling effects and acceptability were calculated. RESULTS: One-hundred and sixty-two patients (mean age = 47.9 ± 14.5 years, 70% female) were included. The CNFDS-I exhibited sufficient unidimensionality (one factor explained 83% of the variability) and internal consistency (α = 0.83). Construct validity was sufficient as all correlations with the other questionnaires were as expected (r = 0.846 with NDI, r = 0.708 with NBQ, r = 0.570 with VAS). Test-retest reliability was excellent (ICCagreement = 0.99, 95% CI from 0.995 to 0.999), while measurement error was equal to 8.31 scale points (27% scale range). No floor/ceiling effects were detected. The average time for filling the questionnaire was two minutes. CONCLUSIONS: The CNFDS-I proved to be a valid and reliable outcome measure to assess disability in patients with chronic neck pain. Head-to-head comparison studies on the CNFDS-I measurement properties against other disability measures for neck pain (e.g. NDI and NBQ) are required to determine the relative merits of these different measures.

[Responsiveness of Chinese version of Neck Outcome Score in subjects with neck pain].

Objective: To analyze responsiveness of Chinese version of Neck Outcome Score (NOOS-C) and provide a reliable measure to assess intervention effect for patients with neck pain. Methods: Cross-cultural adaptation of NOOS was performed according to the Beaton's guidelines for cross-cultural adaptation of self-report measures. Eighty patients with neck pain were recruited between September 2016 and May 2017. Those patients were assessed using NOOS-C and Chinese version of Neck Disability Index (NDI) before and after intervention. And 71 patients completed those questionnaires. The statistic differences of the score of each subscale and the total scale before and after intervention were evaluated by paired-samples t test. Internal responsiveness was determined by effect size (ES) and standardized response mean (SRM) based on the calculated difference before and after intervention. External responsiveness was analyzed by Spearman correlation coefficient. Results: The differences in symptom subscale, sleep disturbance subscale, participating in everyday life subscale, every day activity and pain subscale, and the scale between before and after intervention were significant ( P<0.05) except for mobility subscale ( P>0.05). The difference of NDI-C before and after intervention was -12.11%±17.45%, ES was 0.77, and SRM was 0.69. The difference of NOOS-C before and after intervention was 13.74±17.22, ES was 0.83, and SRM was 0.80. Spearman correlation analysis revealed that the relativity about NOOS-C and NDI-C before and after intervention were both negative ( r=-0.914, P=0.000; r=-0.872, P=0.000). Conclusion: NOOS-C's responsiveness is good.

Cross-Cultural Adaptation of the Profile Fitness Mapping Neck Questionnaire to Brazilian Portuguese: Internal Consistency, Reliability, and Construct and Structural Validity.

OBJECTIVE: The purpose of this study was to adapt and evaluate the psychometric properties of the ProFitMap-neck to Brazilian Portuguese. METHODS: The cross-cultural adaptation consisted of 5 stages, and 180 female patients with chronic neck pain participated in the study. A subsample (n = 30) answered the pretest, and another subsample (n = 100) answered the questionnaire a second time. Internal consistency, test-retest reliability, and construct validity (hypothesis testing and structural validity) were estimated. For construct validity, the scores of the questionnaire were correlated with the Neck Disability Index (NDI), and the Hospital Anxiety and Depression Scale (HADS), the Tampa Scale of Kinesiophobia (TSK), and the 36-item Short-Form Health Survey (SF-36). RESULTS: Internal consistency was determined by adequate Cronbach's α values (α > 0.70). Strong reliability was identified by high intraclass correlation coefficients (ICC > 0.75). Construct validity was identified by moderate and strong correlations of the Br-ProFitMap-neck with total NDI score (-0.56 50%, Kaiser-Meyer-Olkin index > 0.50, eigenvalue > 1, and factor loadings > 0.2. CONCLUSION: Br-ProFitMap-neck had adequate psychometric properties and can be used in clinical settings, as well as research, in patients with chronic neck pain.

Translation, Validation, and Crosscultural Adaptation of the Hebrew Version of the Neck Disability Index.

STUDY DESIGN: The present study's design was translation and crosscultural validation of the Neck Disability Index (NDI). OBJECTIVE: The aim of the study was to translate and culturally adapt the NDI into Hebrew language and to evaluate the psychometric properties of this version. SUMMARY OF BACKGROUND DATA: As yet, no Hebrew language neck pain and disability questionnaires exist. The NDI is widely used and validated among different patient populations with neck pain. METHODS: The English version of the NDI was translated into Hebrew according to the published guidelines. A total of 100 patients with neck pain participated in the study. Inclusion criteria were age 18 years and older, neck pain, and ability to read and speak Hebrew. Exclusion criteria were cancer or suspected tumor, neck pain related to vertebral fracture, or neurological disease. Participants were asked to complete the NDI-Hebrew version (NDI-H), Numeric Pain Rating Scale (NPRS), and Patient-Specific Functional Scale (PSFS). Seventy-three patients completed the NDI-H twice in an interval of 2 days. Psychometric properties included test-retest reliability (intraclass correlation coefficient), internal consistency (Cronbach α), convergent validity (Pearson correlation), and factor analysis. RESULTS: The NDI-H demonstrated excellent test-retest reliability (intraclass correlation coefficient ranged from 0.827 to 0.929; Pv < 0.001). Cronbach α value was excellent (0.855). A very good correlation was found between the NDI-H and NPRS scores (r = 0.611, P < 0.001) and a good correlation between the NDI-H and PSFS score (r = 0.417, P < 0.001). Factor analysis revealed a two-factor solution representing daily function and pain and symptoms. CONCLUSION: The NDI-H is a valid and reliable instrument to measure functional limitations and disability in Hebrew-speaking patients with neck pain. LEVEL OF EVIDENCE: NA.

A longitudinal study on risk factors for neck and shoulder pain among young adults in the transition from technical school to working life.

OBJECTIVES: The study examined the course of neck and shoulder pain among a cohort of technical school students entering working life. We also aimed to identify work-related and individual risk factors for neck and shoulder pain during this transition period. METHODS: The study was designed as a prospective cohort study following 420 technical school students (167 student hairdressers, 118 student electricians, and 135 media/design students) from school, through their apprenticeship and into working life. Every 4 (th)month over a 6.5 year period (2002-2009), the participant`s neck and shoulder pain for the preceding four weeks was assessed. Mechanical and psychosocial workplace factors as well as individual factors were evaluated at baseline and/or during the follow-up period. Data were analyzed by generalized estimating equations (GEE). RESULTS: We found a significant increase in neck and shoulder pain over time in the transition from technical school to working life. High mechanical workload was associated with neck and shoulder pain among women, while a high level of shoulder muscle endurance capacity was associated with lower rates of neck and shoulder pain among men. Perceived muscle tension and ethnicity were the most consistent predictors for neck and shoulder pain, found among both women and men. CONCLUSION: Increased neck and shoulder pain was found in the transition from technical school to working life, and both work-related and individual factors were associated with pain development.

Cross-cultural adaptation, reliability, and validity of the Arabic version of neck disability index in patients with neck pain.

STUDY DESIGN: Translation and psychometric testing. OBJECTIVE: To adapt the neck disability index (NDI) cross-culturally to Arabic language and to investigate the reliability and validity of the Arabic version of NDI in an Arabic-speaking sample with neck pain. SUMMARY OF BACKGROUND DATA: Although largely used, no previous reports exist on the translation process or the testing of the psychometric properties of the Arabic version of the NDI. METHODS: Cross-cultural adaptation of an outcome questionnaire. The English version of the NDI was translated into Arabic (NDI-Ar) and back-translated according to established guidelines. Sixty-five patients with neck pain completed the NDI -Ar twice during a 1-week period, to assess its test-retest reliability. Further psychometric testing was done by assessing internal consistency, construct validity (factor structure), and responsiveness. RESULTS: The internal consistency value (Cronbach α) for the NDI-Ar was 0.89. The test-retest reliability (intraclass correlation coefficient) was excellent at 0.96 (95% confidence interval from 0.93 to 0.97). There was a significant correlation (r = 0.92, P < 0.05) between the scores obtained from the first administration of the NDI-Ar and the second administration. Factor analysis demonstrated a 2-factor structure, explaining 67.58% of total variance. The analysis of responsiveness was calculated with an unpaired t test after 1 week of treatment and demonstrating a statically significant difference between stable and improved patients (P < 0.05). The Spearman correlation coefficient (rS = 0.81; P = 0.000) revealed strong relation between the change in score in the NDI-Ar and global rating of change. No ceiling or floor effects were detected in the NDI-Ar. CONCLUSION: The Arabic version of the NDI has a 2-factor 10-item structure and is a reliable, valid, and responsive tool that can be used to assess neck pain in Arabic-speaking patients with neck pain. Therefore, it can be recommended for clinical and research purposes.

Crosscultural adaptation, reliability, and validity of the Japanese version of the neck disability index.

STUDY DESIGN: Translation and psychometric testing. OBJECTIVE: To translate and culturally adapt the Neck Disability Index (NDI) and to assess the reliability and validity of the Japanese version of the NDI (NDI-J) in Japanese outpatients with neck pain. SUMMARY OF BACKGROUND DATA: To date, no previous report exists on the translation process and psychometric testing of the NDI-J. METHODS: The NDI was translated and culturally adapted into Japanese in accordance with published guidelines. A total of 110 outpatients with neck pain participated in the study. Psychometric testing included reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient), factor analysis, convergent validity by comparing the NDI-J with the short-form health survey (Pearson correlation) and responsiveness (unpaired t tests, standard error of measurement, and minimal detectable change). RESULTS: The Cronbach α of the NDI-J was 0.88 and the intraclass correlation coefficient for test-retest reliability was 0.91 (95% confidence interval, 0.82-0.95). Factor analysis demonstrated a 2-factor structure, explaining 61.8% of the total variance. The correlation between the NDI-J and the short-form health survey, version 36, subscales ranged from good to fair (-0.25 to -0.51). The analysis of responsiveness was calculated with an unpaired t test after 3 weeks of treatment demonstrating a statistically significant difference between the stable and improved patients (P ≤ 0.05). The standard error of measurement and minimal detectable change were calculated as 2.9 and 6.8, respectively. CONCLUSION: The NDI-J is a valid, reliable, and responsive tool that can be used to assess neck pain in Japanese outpatients.

Clinimetric properties of the Turkish translation of a modified neck disability index.

BACKGROUND: Neck pain is a common problem that can greatly affect a person's activities of daily living. Functional status questionnaires are important in assessing this effect, and are used to follow up neck pain management programs. The Neck Disability Index (NDI) is the first-created scale for neck pain-related disability and is widely translated and in common used in many countries. Our aim is investigate to clinometric properties of a Turkish version of modified NDI and to give a choice in daily practise of versions to be used. METHODS: The modified NDI was applied to 30 patients for reliability. 185 patients participated in the validity study. All patients were recruited from the outpatient clinic of our department. The scale was translated by the forward and backward translation procedure according to the COSMIN criteria. The test was repeated at 48 hours interval for reliability study. SPSS-10.0, software was used for statistical analyses. The Intraclass correlation coefficient was used for the test- retest reliability of the modified NDI. Cronbach α was used for internal consistency. Factor analysis was used for construct validity. The validity of the modified NDI with respect to the SF-36, HAD, VAS pain, VAS disability was assessed using Spearman correlations. RESULTS: The Intraclass correlation coefficient between first and second (within 48 hours) evaluation of test (rs) was 0.92. Questions 1,4,6,8,10 were shown to have excellent reliability. (rs > 0.9). Question 10 was the most frequently challenged question because "recreational and social activities" do not have not the same meanings in Turkey than in western countries. This required that detailed explanations be provided by the investigators. Cronbach's alpha for the total index was 0.88. A single factor accounting for 80.2% of the variance was obtained. Validity studies demonstrated good and moderate correlations (rs) among NDI, HAD, VAS, physical function subtitle of SF 36 (0.62, 0.76, 0.68). CONCLUSIONS: The modified NDI-Turkish version is a reliable and valid test and is suitable for daily practise.

Validity and test re-test reliability of the neck disability index in the Nigerian clinical setting.

The neck disability index (NDI) is a valid and widely used clinical instrument, which enjoys the recommendation of the World Health Organization for outcome assessment in neck pain. Its psychometric properties have not been investigated in the Nigerian clinical setting. This study investigated the content validity and test-retest reliability of the NDI in order to encourage its integration in the Nigerian clinical setting. Content validity of NDI was assessed through an expert panel review for content relevance/coverage and pretesting. Thirty two subjects with neck pain, recruited through a purposive sampling technique participated in the study. The NDI was administered twice within 48 hours interval. Data were summarized in percentages. Intra class correlation coefficient was used to analyze data for test-retest reliability with alpha set at 0.05. Participants were 1 males, 21 females with a majority within age group 38-57. Twenty four (75%) participants had mild to moderate disability, 7 (21.9%) had severe to complete disability and one individual had no disability. There was a significant correlation (r = 0.969, P=0.01) between the scores obtained from the first administration of the NDI and the second administration. The NDI is a valid and reliable outcome measure and it is recommended for integration into the assessment of neck pain in the Nigerian clinical setting.

Racial/Ethnic and gender prevalences in reported common pains in a national sample.

AIMS: To compare prevalences of self-reported temporomandibular joint and muscle disorders (TMJMD)-type pain, headaches, and neck and back pains in the 2000 to 2005 US National Health Interview Survey (NHIS) by gender and age for non-Hispanic Whites (Whites), Hispanics, and non-Hispanic Blacks (Blacks). METHODS: Data from the 2000 to 2005 NHIS included information on gender, age, race, ethnicity, and different common types of pain specifically: TMJMD-type pain, severe headaches/migraine, neck, and low back pains. RESULTS: A total of 189,992 people were included: 52% female and 48% male, 73% White, 12% Hispanic, 11% Black, and 4% "Other." The overall prevalence of TMJMD-type pain was 4.6%; severe headaches/migraine was 15.4%; neck, 14.9%; and low back, 28.0%. Survey logistic regression models estimating race-specific, age-adjusted curves revealed race by age pain differences. For TMJMD-type pain, White females presented the highest prevalence at younger ages, decreasing after age 40. Prevalences for Hispanic and Black females, although lower at younger ages, increased up to age 60 and remained higher than Whites. Males showed less racial/ethnic and age variation. Severe headaches/migraines presented an age pattern similar to TMJMD-type pain for White females and little overall variation for males, but without racial differences. Neck pain showed some similarities to TMJMD-type pain: higher in Whites at younger ages, lower at older ages, with Hispanics having the highest rates after their 60's. For low back pain, the rates peaked around the sixth decade for all racial/ethnic groups. CONCLUSION: The patterns of TMJMD-type pain varied greatly within and across racial/ethnic groups by gender and across the adult lifespan. Similarities and differences for the other pains were noted.

Validation of Thai versions of the Neck Disability Index and Neck Pain and Disability Scale in patients with neck pain.

STUDY DESIGN: Cross-cultural validation of the Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDS). OBJECTIVE: To translate and test the psychometric properties of Thai versions of the NDI and NPDS questionnaires. SUMMARY OF BACKGROUND DATA: The NDI and NPDS are questionnaires commonly used to measure neck pain and disability. The original versions of the NDI and NPDS have been translated into many languages but there are no validated Thai versions. METHODS: Translation and cross-cultural adaptation of the original English versions of the NDI and NPDS were performed according to published guidelines. A total of 185 patients with neck pain participated in the study and were asked to complete the Neck Disability Index-Thai version (NDI-TH), Neck Pain Disability Scale-Thai version (NPDS-TH), and a visual analogue scale (VAS; 0-10). Psychometric evaluation included factor analysis, internal consistency, test-retest reliability, agreement, and convergent validity. Test-retest reliability for the NDI-TH was examined in 20 patients and in 17 for the NPDS-TH. Patients completed the questionnaires twice with an interval of 48 hours. RESULTS: Factor analysis revealed a single-factor solution for the NDI-TH and three factor solution for the NPDS-TH. Cronbach α values for the NDI-TH and NPDS-TH were excellent (0.85 and 0.96, respectively). The three NPDS-TH subscales ranged from 0.90 to 0.94. Good to excellent test-retest reliability was demonstrated for all measurements (Intraclass Correlation Coefficient range = 0.74-0.91, P < 0.001). The NDI-TH, NPDS-TH, and NPDS-TH subscales were moderately correlated with the VAS (range, r = 0.61-0.76, P < 0.001). The minimal detectable change was 16.1 points for the NDI-TH (scale range = 0-100) and 21.8 points for NPDS-TH (scale range = 0-100). CONCLUSION: The NDI-TH and NPDS-TH seem to be reliable instruments to measure functional limitation and disability in Thai patients with neck pain. However, further research is still needed to determine responsiveness and validity of these questionnaires.

Immigration, acculturation and chronic back and neck problems among Latino-Americans.

Higher acculturation is associated with increased obesity and depression among Latino-Americans, but not much is known about how acculturation is related to their prevalence of back and neck problems. This study examines whether acculturation is associated with the 12-month prevalence of self-reported chronic back or neck problems among US-born and immigrant Latinos. We performed multivariable logistic regression analysis of data from 2,553 noninstitutionalized Latino adults from the 2002-2003 National Latino and Asian American Survey (NLAAS). After adjusting for demographic, physical and mental health indicators, English proficiency, nativity and higher generational status were all significantly positively associated with the report of chronic back or neck problems. Among immigrants, the proportion of lifetime in the US was not significantly associated. Our findings suggest that the report of chronic back or neck problems is higher among more acculturated Latino-Americans independent of health status, obesity, and the presence of depression.

Neck pain in Hong Kong: a telephone survey on consequences and health service utilization.

STUDY DESIGN: A regionally representative telephone survey using a 2-stage randomization process. OBJECTIVE: (1) To investigate the prevalence and consequence of neck pain in terms of disability and rate of absenteeism from work. (2) To describe the health services utilization pattern of neck pain subjects and to analyse the factors associated with neck pain and health services utilization pattern. SUMMARY OF BACKGROUND DATA: There has been a lack of reliable information on the health service utilization pattern of neck pain subjects, the consequences and the patient perceived effectiveness of neck pain management in Hong Kong and Asian countries. METHODS: Subjects were interviewed on the sociodemographic characteristics, occurrence and consequences of neck pain, and the health utilization pattern. A random sample of the respondents was re-interviewed 7 to 10 days after the initial interview, by an independent interviewer for the reliability check. RESULTS: A total of 4640 subjects were interviewed. The 12-month prevalence was 64.6% (95% CI: 63.2%-66.0%). About 38.0% of these patients suffered from moderate to severe pain. Moreover, 17.7% of these subjects had to limit their social activities and 19% had to limit their work. About 25% of those subjects had consulted medical or health practitioners. Medical consultation is the majority and physiotherapy came second. Self-massage was the most preferred (83.3%) mode of self-care. Physiotherapy was regarded as the most effective health service, with 60% of the respondents' neck pain completely removed. Although most people chose self-massage to be the most effective self-care treatment, only one-third (30.2%) of them had their neck pain improved by less than a half. CONCLUSION: Neck pain is highly prevalent with an increasing impact in Hong Kong. More than one-third of neck pain patients suffered from moderate to severe pain and around 20% of them had to limit their work. About 25% of neck pain patient have consulted medical or health professionals. Physiotherapy and private medical clinic were the 2 service providers with high percentage of perceived complete improvement. There was a general trend that more neck pain patients used complementary therapies.

The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study.

STUDY DESIGN: The cultural adaptation of Neck Disability Index (NDI), the validity and reliability of Turkish version. OBJECTIVE: The aim of this study was to conduct a study concerning the cultural adaptation of NDI and investigate the validity and reliability of its Turkish version in patients with neck pain. SUMMARY OF BACKGROUND DATA: The NDI is a reliable evaluation instrument for disability but there is no published Turkish version. METHODS: Eighty-eight patients with neck pain for at least 3 months were included in the study. NDI, The Neck Pain and Disability Scale, and Visual Analogue Scale (VAS) were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson correlation analysis. For the determination of concurrent validity, the relation between NDI and VAS was examined by Pearson correlation analysis and for the determination of construct validity, the relation between NDI and Neck Pain and Disability Scale was investigated. RESULTS: Intraclass correlation coefficient score for test-retest reliability was 0.979 (95% confidence interval = 0.968-0.986). For concurrent validity, the relation between NDI and VAS was investigated, the r value for test and retest was 0.508 and 0.620, respectively (P < 0.0001). For construct validity, the relation between NDI and the Turkish version of Neck Pain and Disability Scale was investigated, the r value for test and retest was 0.659 (P < 0.0001) and 0.728 (P < 0.0001), respectively. CONCLUSION: The results suggest that the Turkish version of the NDI validated in this study is an easy to understand, reliable, and valid instrument for the measurement of the limitation of activities of daily living and pain caused by neck disorders in the Turkish-speaking population.

Translation of the Neck Disability Index and validation of the Greek version in a sample of neck pain patients.

BACKGROUND: Neck pain is a highly prevalent condition resulting in major disability. Standard scales for measuring disability in patients with neck pain have a pivotal role in research and clinical settings. The Neck Disability Index (NDI) is a valid and reliable tool, designed to measure disability in activities of daily living due to neck pain. The purpose of our study was the translation and validation of the NDI in a Greek primary care population with neck complaints. METHODS: The original version of the questionnaire was used. Based on international standards, the translation strategy comprised forward translations, reconciliation, backward translation and pre-testing steps. The validation procedure concerned the exploration of internal consistency (Cronbach alpha), test-retest reliability (Intraclass Correlation Coefficient, Bland and Altman method), construct validity (exploratory factor analysis) and responsiveness (Spearman correlation coefficient, Standard Error of Measurement and Minimal Detectable Change) of the questionnaire. Data quality was also assessed through completeness of data and floor/ceiling effects. RESULTS: The translation procedure resulted in the Greek modified version of the NDI. The latter was culturally adapted through the pre-testing phase. The validation procedure raised a large amount of missing data due to low applicability, which were assessed with two methods. Floor or ceiling effects were not observed. Cronbach alpha was calculated as 0.85, which was interpreted as good internal consistency. Intraclass correlation coefficient was found to be 0.93 (95% CI 0.84-0.97), which was considered as very good test-retest reliability. Factor analysis yielded one factor with Eigenvalue 4.48 explaining 44.77% of variance. The Spearman correlation coefficient (0.3; P = 0.02) revealed some relation between the change score in the NDI and Global Rating of Change (GROC). The SEM and MDC were calculated as 0.64 and 1.78 respectively. CONCLUSION: The Greek version of the NDI measures disability in patients with neck pain in a reliable, valid and responsive manner. It is considered a useful tool for research and clinical settings in Greek Primary Health Care.

The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study.

OBJECTIVES: The aim of this study was to conduct the cross-cultural adaptation of Neck Disability Index (NDI) and investigate the validity and reliability of Turkish version in patients with neck pain. SUMMARY OF BACKGROUND DATA: The NDI is a reliable evaluation instrument for disability but there are no published Turkish version. METHODS: Eighty-eight patients with neck pain for at least 3 months were included in the study. NDI, The Neck Pain and Disability Scale and Visual Analogue Scale (VAS) were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson's correlation analysis. For the determination of concurrent validity, the relation between NDI and VAS was examined by Pearson's correlation analysis and for the determination of construct validity, the relation between NDI and Neck Pain and Disability Scale was investigated. RESULTS: Intraclass correlation coefficient score for test-retest reliability was 0.979 (95%, confidence interval = 0.968-0.986). For concurrent validity, the relation between NDI and VAS was investigated, the r value for test and retest was 0.508 and 0.620, respectively (P < 0.0001). For construct validity, the relation between NDI and the Turkish version of NPDA was investigated, the r value for test and retest was 0.659 (P < 0.0001) and 0.728 (P < 0.0001), respectively. CONCLUSION: The Turkish version of NDI was found to be a valid and reliable method of measurement for evaluating disability, caused by problems of the neck region as it is easy to comprehend by the patients and the time needed to apply is short in clinics.

Translation and validation study of the Iranian versions of the Neck Disability Index and the Neck Pain and Disability Scale.

STUDY DESIGN: Cultural translation and psychometric testing. OBJECTIVE: To translate and validate the Iranian versions of the Neck Disability Index (NDI-IR) and the Neck Pain and Disability Scale (NPDS-IR). SUMMARY OF BACKGROUND DATA: The widely used the NDI and the NPDS scales have not been translated and validated for Persian-speaking patients with neck pain. This was to provide a validated instrument to measure functional status in patients with neck pain in Iran. METHODS: The translation and cultural adaptation of the original questionnaires were carried out in accordance with the published guidelines. One hundred and eighty-five patients with neck pain were participated in the study. Patients were asked to complete a questionnaire booklet including the NDI-IR, the NPDS-IR, the Iranian SF-36, and a visual analog scale (VAS) of pain. To carry out the test-retest reliability, 30 randomly selected patients with neck pain were asked to complete the questionnaire booklet 48 hours later for the second time. RESULTS: Cronbach alpha coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory (ranging from 0.74 to 0.94). The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability (intraclass correlation coefficient ranged from 0.90 to 0.97; P < 0.01). The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results, indicating a good convergent validity (Pearson correlation coefficients ranged from -0.31 to -0.70). The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 (P < 0.01). CONCLUSION: The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran. They are simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian speaking communities.