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Confirmatory factor analysis of the neck disability index, comparing patients with whiplash associated disorders to a control group with non-specific neck pain

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Abstract

Purpose The neck disability index (NDI) as a 10-item patient reported outcome (PRO) measure is the most commonly used whiplash associated disorders (WAD) assessment tool. However, statistical rigor and factor structure are not definitive. To date, confirmatory factor analysis (CFA) has not examined whether the factor structure generalizes across different groups (e.g., WAD versus non-WAD). This study aimed to determine the psychometric properties of the NDI in these population groups.

Methods

This study used CFA to analyze NDI baseline-data for WAD (n = 804; 69 % females) and non-WAD (n = 963; 67 % females), each for the full sample and separate genders. Invariance analyses examined the NDI structure across the four groups.

Results

Across both populations and gender subgroups the one-factor solutions consistently showed better model fit over two-factor solutions. The NDI was best characterized as one-dimensional and invariant across multiple sub-groups.

Conclusion

The NDI remains a valid PRO in WAD populations that provides acceptable measurement of neck status that is appropriate for basic functional assessment across genders. However, it is recommended that both clinicians and researchers initiate the transition toward more rigorous and less ambiguous PRO measurement tools for WAD patients and research. This future graduated movement toward other PROs should consider both regional PROs and computerized decision support systems, initially measured concurrently with the NDI to establish ways to convert existing scored data prior to their singular use.

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Acknowledgments

We would like to thank all participating researchers and patients who contributed data to the study. This included the University of the Sunshine Coast, Queensland, Australia, Faculty of Medicine Malaga University, Spain, University of Queensland, Mobile Spine and Rehabilitation Centre USA, The Melbourne Whiplash Centre staff and patients, Victoria, Australia and Complejo Hospitalraio Ciudad de Jaen, Spain. The study was a secondary analysis of existing de-identified data that had Human Research Ethics Committee Approval from each of the contributing researchers’ institution.

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Authors and Affiliations

  1. Private Researcher, Coolum Physiotherapy, Coolum Beach, QLD, Australia

    Charles Philip Gabel

  2. Department of Psychiatry and Physiotherapy, Faculty of Medicine, Malaga University, Malaga, Spain

    Antonio Cuesta-Vargas

  3. Department of Counselling and Human Development, University of Louisville, Louisville, KY, USA

    Sebastian Barr & Stephanie Winkeljohn Black

  4. Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland

    Markus Melloh

  5. Centre for Medical Research, University of Western Australia, Nedlands, Australia

    Markus Melloh

  6. Department of Mathematical Sciences and the Graduate School, Clemson University, Clemson, SC, USA

    Jason W. Osborne

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  1. Charles Philip Gabel
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Correspondence to Charles Philip Gabel.

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Gabel, C.P., Cuesta-Vargas, A., Barr, S. et al. Confirmatory factor analysis of the neck disability index, comparing patients with whiplash associated disorders to a control group with non-specific neck pain. Eur Spine J 25, 2078–2086 (2016). https://doi.org/10.1007/s00586-016-4543-z

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