Skip to main content

Advertisement

SpringerLink
Log in

Responsiveness and minimal important changes for the Neck Disability Index and the Neck Pain Disability Scale in Italian subjects with chronic neck pain

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the responsiveness and minimal important changes (MICs) for the Italian Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) as well as which questionnaire was the most responsive in subjects with chronic neck pain (NP).

Methods

At the beginning and end of an 8-week rehabilitation programme, 200 patients completed the NDI and NPDS. After the programme, the global perceived effect (GPE) was also evaluated and collapsed to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods (ROC curves; correlations between change scores of NPDS and NDI, and GPE). ROC curves were also used to compute the best cutoff levels between improved and stable subjects (MICs).

Results

The ES was 0.66 and 0.73, and the SRM was 1.09–1.26 for the NDI and NPDS, respectively. The ROC analyses revealed AUCs of 0.96 and 0.91 for the NDI and NPDS, respectively; the MICs were 7-percentage points for the NDI (sensitivity: 98 %; specificity: 81 %) and 10 for NPDS (93; 83 %), showing equivalent responsiveness properties. Baseline NPDS scores did not affect MIC estimate for the NPDS, while, for the NDI, higher MICs were found for patients with worst disability levels. Correlations between change scores of the NDI and NPDS and GPE were, respectively, high (0.71) and moderate (0.59).

Conclusions

The Italian NDI and NPDS were equally sensitive in detecting clinical changes in subjects with chronic NP undergoing rehabilitation. We recommend taking the MICs into account when assessing patient improvement or planning studies in this clinical context.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Revicki D, Hays RD, Cella D, Sloan J (2008) Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 61:102–109

    Article  PubMed  Google Scholar 

  2. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient reported outcomes. J Clin Epidemiol 63(7):737–745

    Article  PubMed  Google Scholar 

  3. de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM (2006) Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 4:54

    Article  PubMed Central  PubMed  Google Scholar 

  4. Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 14:409–415

    CAS  PubMed  Google Scholar 

  5. Vernon H (2008) The Neck Disability Index: state-of-the-art, 1991–2008. J Manipulative Physiol Ther 31:491–502

    Article  PubMed  Google Scholar 

  6. Wheeler AH, Goolkasian P, Baird AC, Darden BV 2nd (1999) Development of the Neck Pain and Disability Scale: item analysis, face, and criterion-related validity. Spine 24:1290–1294

    Article  CAS  PubMed  Google Scholar 

  7. Goolkasian P, Wheeler AH, Gretz SS (2002) The neck pain and disability scale: test-retest reliability and construct validity. Clin J Pain 18:245–250

    Article  PubMed  Google Scholar 

  8. Monticone M, Ferrante S, Vernon H, Rocca B, Dal Farra F, Foti C (2012) Development of the Italian version of the Neck Disability Index. Cross-cultural adaptation, factor analysis, reliability, validity and sensitivity to change. Spine (Phila Pa 1976) 37(17):E1038–E1044

    Article  Google Scholar 

  9. Monticone M, Baiardi P, Nido N, Righini C, Tomba A, Giovanazzi E (2008) Development of the Italian version of the Neck Pain and Disability Scale, NPDS-I. Spine (Phila Pa 1976) 33:E429–E434

    Article  Google Scholar 

  10. Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468

    Article  CAS  PubMed  Google Scholar 

  11. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 18(10):22

    Article  Google Scholar 

  12. Monticone M, Baiardi P, Vanti C, Ferrari S, Nava T, Montironi C, Rocca B, Foti C, Teli M (2012) Chronic neck pain and treatment of cognitive and behavioural factors. Results of a randomised controlled clinical trial. Eur Spine J 21(8):1558–1566

    Article  PubMed Central  PubMed  Google Scholar 

  13. Kamper SJ, Ostelo RW, Knol DL, Maher CG, de Vet HC, Hancock MJ (2012) Global perceived effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status. J Clin Epidemiol 63:760–766

    Article  Google Scholar 

  14. Zweig M, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577

    CAS  PubMed  Google Scholar 

  15. Schuller W, Ostelo RW, Janssen R, de Vet HC (2014) The influence of study population and definition of improvement on the smallest detectable change and the minimal important change of the neck disability index. Health Qual Life Outcomes 12(1):53

    Article  PubMed Central  PubMed  Google Scholar 

  16. de Vet HCW, Terwee CB, Mokkink LB, Knol DL (2011) Measurement in medicine. A practical guide. Cambridge University Press, Cambridge

    Book  Google Scholar 

  17. Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H (2001) A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 26:788–797

    Article  CAS  PubMed  Google Scholar 

  18. Evans R, Bronfort G, Nelson B, Goldsmith CH (2002) Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine 27:2383–2389

    Article  PubMed  Google Scholar 

  19. Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Devillé WL, Pool JJ, Scholten RJ, Bouter LM (2002) Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain—a randomized, controlled trial. Ann Intern Med 136:713–722

    Article  PubMed  Google Scholar 

  20. Kjellman G, Oberg B (2002) A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain. J Rehabil Med 34:183–190

    Article  PubMed  Google Scholar 

  21. Hoving JL, De Vet HCW, Koes BW, van Mameren H, Deville WLJM, van der Windt DAWM, Assendelft WJJ, Pool JJM, Scholten RJPM, Korthals–De Bos IBC, Bouter LM (2006) Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain—long-term results from a pragmatic randomized clinical trial. Clin J Pain 22:370–377

    Article  PubMed  Google Scholar 

  22. Kietrys DM, Galper JS, Verno V (2007) Effects of at-work exercises on computer operators. Work 28:67–75

    PubMed  Google Scholar 

  23. Lee H, Nicholson LL, Adams RD, Maher CG, Halaki M, Bae SS (2006) Development and psychometric testing of Korean language versions of 4 neck pain and disability questionnaires. Spine 31:1841–1845

    Article  PubMed  Google Scholar 

  24. Kose G, Hepguler S, Atamaz F, Oder G (2007) A comparison of four disability scales for Turkish patients with neck pain. J Rehabil Med 39:358–362

    Article  PubMed  Google Scholar 

  25. Stratford PW, Riddle DL, Binkley JM, Spadoni G, Westaway MD, Padfield B (1999) Using the Neck Disability Index to make decisions concerning individual patients. Physiother Can 51:107–112

    Google Scholar 

  26. Pool JJ, Ostelo RW, Hoving JL, de Bouter LM, Vet HC (2007) Minimal clinically important change of the Neck Disability Index and the Numerical Rating Scale for patients with neck pain. Spine 32:3047–3051

    Article  PubMed  Google Scholar 

  27. Cleland JA, Childs JD, Whitman JM (2008) Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil 89(1):69–74

    Article  PubMed  Google Scholar 

  28. Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD (2009) Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J 9(10):802–808

    Article  PubMed  Google Scholar 

  29. Jorritsma W, Dijkstra PU, de Vries GE, Geertzen JH, Reneman MF (2012) Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index. Eur Spine J 21(12):2550–2557.24

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all the physiotherapists who took part in the study.

Conflict of interest

None.

Ethical standard

Our institutional review board approved the research and the study was conducted in conformity with ethical and humane principles of research.

Author information

Authors and Affiliations

  1. Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Institute of Care and Research (IRCCS), Salvatore Maugeri Foundation, Via Monsignor Bernasconi, 16, 20035, Lissone, Milan, Italy

    Marco Monticone, Emilia Ambrosini, Roberto Brunati & Barbara Rocca

  2. Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy

    Emilia Ambrosini & Simona Ferrante

  3. Canadian Memorial Chiropractic College, Toronto, ON, Canada

    Howard Vernon

  4. Chair of Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy

    Calogero Foti

Authors
  1. Marco Monticone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emilia Ambrosini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Howard Vernon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Brunati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Rocca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Calogero Foti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simona Ferrante
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Monticone.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Monticone, M., Ambrosini, E., Vernon, H. et al. Responsiveness and minimal important changes for the Neck Disability Index and the Neck Pain Disability Scale in Italian subjects with chronic neck pain. Eur Spine J 24, 2821–2827 (2015). https://doi.org/10.1007/s00586-015-3785-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-3785-5

Keywords

Search

Navigation