Neck Disability Index (NDI)

Evaluates the degree of perceived pain neck and the disability status.

You can read more about this disability index and its interpretation in the text below the calculator.

The neck disability index consists of a series of activities of daily living that the subject is asked to evaluate in respect to perceived neck and cervical spine pain.

The NDI is based upon the Oswestry Low Back Pain Disability Index and is a self-report condition specific questionnaire. It is aimed at becoming the first assessment of patients with neck pain, especially that caused by trauma.

Each of the 10 items in the score is awarded a number of points which is then summed to provide the final result.

This is a numeric value which can be transformed in percentage (by multiplication by 2) and is associated with a level of disability.

NDI result (points)	NDI result (percentage)	Interpretation (level of disability)
0 – 4	0 – 8%	None
5 – 14	10 – 28%	Mild
15 – 24	30 – 48%	Moderate
25 – 34	50 – 64%	Severe
35 – 50	70 – 100%	Complete

Pain Intensity

A. I have no pain at the moment

B. The pain is mild at the moment

C. The pain comes and goes and is moderate

D. The pain is moderate and does not vary much

E. The pain is severe but comes and goes

F. The pain is severe and does not vary much

Personal Care (Washing, Dressing etc.)

A. I can look after myself without causing extra pain

B. I can look after myself normally but it causes extra pain

C. It is painful to look after myself and I am slow and careful

D. I need some help, but manage most of my personal care

E. I need help every day in most aspects of self-care

F. I do not get dressed, I wash with difficulty and stay in bed

Lifting

A. I can lift heavy weights without extra pain

B. I can lift heavy weights, but it causes extra pain

C. Pain prevents me from lifting heavy weights off the floor but I can if they are conveniently positioned, for example on a table

D. Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

E. I can lift very light weights

F. I cannot lift or carry anything at all

Reading

A. I can read as much as I want to with no pain in my neck

B. I can read as much as I want with slight pain in my neck

C. I can read as much as I want with moderate pain in my neck

D. I cannot read as much as I want because of moderate pain in my neck

E. I cannot read as much as I want because of severe pain in my neck

F. I cannot read at all

Headache

A. I have no headaches at all

B. I have slight headaches which come infrequently

C. I have moderate headaches which come in-frequently

D. I have moderate headaches which come frequently

E. I have severe headaches which come frequently

F. I have headaches almost all the time

Concentration

A. I can concentrate fully when I want to with no difficulty

B. I can concentrate fully when I want to with slight difficulty

C. I have a fair degree of difficulty in concentrating when I want to

D. I have a lot of difficulty in concentrating when I want to

E. I have a great deal of difficulty in concentrating when I want to

F. I cannot concentrate at all

Work

A. I can do as much work as I want to

B. I can only do my usual work, but no more

C. I can do most of my usual work, but no more

D. I cannot do my usual work

E. I can hardly do any work at all

F. I cannot do any work at all

Driving

A. I can drive my car without neck pain

B. I can drive my car as long as I want with slight pain in my neck

C. I can drive my car as long as I want with moderate pain in my neck

D. I cannot drive my car as long as I want because of moderate pain in my neck

E. I can hardly drive my car at all because of severe pain in my neck

F. I cannot drive my car at all

Sleeping

A. I have no trouble sleeping

B. My sleep is slightly disturbed (less than 1 hour sleepless)

C. My sleep is mildly disturbed (1-2 hours sleepless)

D. My sleep is moderately disturbed (2-3 hours sleepless)

E. My sleep is greatly disturbed (3-5 hours sleepless)

F. My sleep is completely disturbed (5-7 hours sleepless)

Recreation

A. I am able engage in all recreational activities with no pain in my neck at all

B. I am able engage in all recreational activities with some pain in my neck

C. I am able engage in most, but not all recreational activities because of pain in my neck

D. I am able engage in a few of my usual recreational activities because of pain in my neck

E. I can hardly do any recreational activities because of pain in my neck

F. I cannot do any recreational activities at all

Send Us Your Feedback

Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

NDI explained

This is a self report questionnaire that evaluates the degree of disability in patients with injuries to the cervical spine (that cause chronic disability).

It is based and adapted from the Oswestry Low Back Pain Disability Index. There are 10 items that assess functional status (related to activities of daily living):

NDI item	Description
Pain Intensity	Pain occurrence and perceived severity
Personal Care	Ability to care for oneself and degree of perceived accuracy in doing so
Lifting	Capacity to lift different weights with or without pain
Reading	Degree of experienced pain in the neck during and in different reading positions
Headache	Frequency and perceived severity of recurrent headaches
Concentration	Degree of difficulty encountered when trying to concentrate
Work	Comparison between current and past work capacity
Driving	Ability to drive and length of time to drive before pain occurs
Seeping	Quantification of sleep disturbance
Recreation	Perceived impairment to partaking in leisure activities

The assessment is recommended to be applied at 2-week intervals, because it can help monitor response to treatment.

The cervical conditions for which the NDI can be applied include:

■ Mechanical neck pain;

■ Cervical radiculopathy;

■ Whiplash Associated Disorders (WAD);

■ Chronic, non-specific neck pain;

■ Chronic, non-traumatic and chronic uncomplicated neck pain;

■ Degenerative, post-traumatic and other neck pain.

Result interpretation

Each of the 10 items in the NDI is awarded a number of points from 0 to 5, therefore the overall score range is between 0 and 50.

Scores closer to 0 indicate little neck pain and discomfort while scores closer to 50 indicate a severe degree of pain and disability that limits activities considerably.

Patients in recovery after injury, score in the range 5 to 20 points.

The score in points can be transformed in a percentage of function.

There are no specific cut-off points but the original score provides an interpretation of the scores in terms of level of disability:

NDI score (points)	NDI score (percentage)	Interpretation (level of disability)
0 – 4	0 – 8%	None
5 – 14	10 – 28%	Mild
15 – 24	30 – 48%	Moderate
25 – 34	50 – 64%	Severe
35 – 50	70 – 100%	Complete

The Minimum Detectable Change (90% confidence) is 5 points or 10 %, in subsequent evaluations, in most conditions. However, in mechanical neck pain MDC is 10 (20%) and in cervical radiculopathy is 13 (26%).

The NDI is only criticised for not including psychosocial and emotional aspects of neck disabilities, despite their common occurrence in patients with chronic neck pain, cervical radiculopathy and whiplash associated disorders.

About the study

The NDI was published by Vernon and Mior in 1991 as a modification of the Oswestry Low Back Pain Index, that is addressed to patients with neck pain.

Face validity was ensured through peer-review and patient feedback sessions. The index was also checked for test-retest reliability on a sample of 17 whiplash injured patients.

The alpha coefficients were calculated from a pool of questionnaires completed by 52 patients whilst concurrent validity was assessed on a subset of 10 and then 30 patients. In the larger subset, the NDI results were compared to scores on the McGill Pain Questionnaire (and achieved moderately high correlations).

The neck disability index is an assessment with a high degree of reliability and internal consistency.

Original source

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7):409-15.

Other references

1. Hains F, Waalen J, Mior S. Psychometric properties of the neck disability index. Journal of Manipulative and Physiological Therapeutics 1998; 21(2):75-80.

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

3. Hogg-Johnson S. Differences in reported psychometric properties of the Neck Disability Index: patient population or choice of methods? Spine J. 2009; 9(10):854-6.

Specialty: Disability

Objective: Evaluation

Type: Index

No. Of Items: 10

Year Of Study: 1991

Abbreviation: NDI

Article By: Denise Nedea

Published On: June 14, 2017 · 10:25 AM

Last Checked: June 14, 2017

Next Review: June 14, 2023