Psychometric characteristics of the Spanish version of instruments to measure neck pain disability

Abstract

BackgroundThe NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Questionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ).MethodsTranslation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed.ResultsComprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. Validity: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15.ConclusionAlthough most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistance.Trial RegistrationClinical Trials Register NCT00349544.

Patients With Neck Pain are Less Likely to Improve if They Experience Poor Sleep Quality

“…This is consistent with data from previous studies within the SNHS, in which losses to followup remain low until 3 months, and rise substantially thereafter. 22,31,35,39,[41][42][43] The main limitations of this study are that SQ was selfreported, and that NP among the recruited patients was mild. SQ was assessed through the PSQI, a validated questionnaire that is based on self-report, 24 and no objective measures such as actigraphy or polysomnography were used.…”

“…Previous studies have assessed the validity, reliability, and responsiveness of these scales and questionnaires. [22][23][24][25][26][27][28] 3 months among patients seeking care for NP are <15% 23,31,32 ; and (3) in that setting, the proportion of patients who show a clinically relevant improvement in NP at 3 months is <90%. 32 For this study, it was anticipated that SQ would improve in Z30% of the patients experiencing pain improvement and in r10% of those who do not.…”

Methodological Quality of Studies on the Measurement Properties of Neck Pain and Disability Questionnaires: A Systematic Review

“…In some articles, multiple questionnaires were evaluated. The following questionnaires were studied: the Neck Disability Index was evaluated in 24 studies 1, ; the Neck Pain and Disability Scale in 13 studies 2,9,21,22,24,25,29,[32][33][34][35][36][37] ; the Neck Bournemouth Questionnaire in 5 studies 12,38-41 ; the Northwick Park Neck Pain Questionnaire in 10 studies 14,21,22,26,29,[42][43][44][45][46] ; the Copenhagen Neck Functional Disability Scale in 4 studies 17,29,47,48 ; the Core Neck Questionnaire in 2 studies 26,49 ; the Whiplash Disability Questionnaire in 3 studies [50][51][52] ; and the Core Whiplash Outcome Measure in 1 study. 53 Internal consistency was evaluated in 35 studies (8 questionnaires); reliability in 36 studies (7 questionnaires); measurement error in 21 studies (6 questionnaires); content validity in 16 studies (6 questionnaires); structural validity in 11 studies (4 questionnaires); construct validity (hypotheses testing) in 41 studies (8 questionnaires); and responsiveness in 37 studies (8 questionnaires).…”

The perceptions of people with low back pain treated in the Spanish National Health, and their experience while undergoing a new evidence-based treatment. A focus group study

“…However, certain psychological variables which are important for people with LBP in these cultural contexts, such as fear-avoidance beliefs and catastrophizing [16][17][18][19][20][21][22][23], have shown to be irrelevant in Southern Europe [24][25][26][27][28][29][30][31]. These differences might suggest variations in the experiences of LBP across these cultural settings.…”