European Spine Journal

, Volume 23, Issue 4, pp 863–872 | Cite as

Reliability, validity and responsiveness of the cross-culturally adapted Italian version of the core outcome measures index (COMI) for the neck

  • Marco MonticoneEmail author
  • Simona Ferrante
  • Serena Maggioni
  • Gisel Grenat
  • Giovanni A. Checchia
  • Marco Testa
  • Marco G. Teli
  • Anne F. Mannion
Original Article



Evaluation of the psychometric properties of a cross-culturally adapted questionnaire, the Core Outcome Measurement Index for neck pain (COMI-neck).


The COMI-neck was cross-culturally adapted for the Italian language using established procedures. The following psychometric properties of the instrument were then assessed in patients with chronic neck pain undergoing rehabilitation: test–retest reliability (intraclass correlation coefficient, ICC); construct validity by comparing COMI-neck with the Neck Pain and Disability Scale, a numerical pain rating scale, and the EuroQol-Five Dimension (Pearson’s correlations); and responsiveness by means of Standardized Response Mean (SRM), unpaired t tests, and Receiver Operating Characteristics (ROC) curves.


The questionnaire was completed by 103 subjects. The COMI-neck summary score displayed no relevant floor or ceiling effects. Test–retest reliability was excellent (ICC = 0.87). With one exception (symptom-specific well-being), the individual COMI items and the COMI summary score correlated to the expected extent with the scores of the reference questionnaires (r = 0.40–0.80). The mean change scores for the Italian COMI-neck differed significantly between patients with a good global outcome and those with a poor outcome (p = 0.002); SRM for the good outcome group was 1.23, and for the poor outcome group 0.40. ROC analysis revealed an area under the curve of 0.73 (95 % CI: 0.62–0.85).


This study provides evidence that the Italian version of the COMI-neck is a valid and responsive questionnaire in the population of patients examined. Its use is recommended for clinical and research purposes.


COMI-neck Outcome Rehabilitation Chronic neck pain 



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


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Marco Monticone
    • 1
    Email author
  • Simona Ferrante
    • 2
  • Serena Maggioni
    • 1
  • Gisel Grenat
    • 3
  • Giovanni A. Checchia
    • 3
  • Marco Testa
    • 4
  • Marco G. Teli
    • 5
  • Anne F. Mannion
    • 6
  1. 1.Operative Unit of Physical Medicine and Rehabilitation, Scientific Institute of Lissone, Salvatore Maugeri FoundationInstitute of Care and Research (IRCCS)Lissone (Milan)Italy
  2. 2.Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
  3. 3.Physical Medicine and Rehabilitation DepartmentSanta Corona HospitalPietra LigureItaly
  4. 4.Dipartimento di Neuroscienze, Riabilitazione, Genetica, Oftalmologia e Scienze Materno-InfantiliGenova UniversitySavonaItaly
  5. 5.Department of OrthopaedicsRegional HospitalLegnanoItaly
  6. 6.Spine CenterSchulthess KlinikZurichSwitzerland

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