Home Medicine The Norwegian version of the Neck Disability Index (NDI) is reliable and sensitive to changes in pain-intensity and consequences of pain-in-the-neck
Article Publicly Available

The Norwegian version of the Neck Disability Index (NDI) is reliable and sensitive to changes in pain-intensity and consequences of pain-in-the-neck

  • Harald Breivik EMAIL logo
Published/Copyright: January 1, 2014
Download Article (PDF)
Become an author with De Gruyter Brill
Author Information Explore this Subject
Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 5 Issue 1

In this issue of the Scandinavian Journal of Pain Jan Borre Johansen and his co-workers publish an important study in which they have validated the Norwegian version of the Neck Disability Index (NDI) [1]. This questionnaire has been in wide use globally for almost a quarter of a century [2]. It is thoroughly validated as a reliable outcome-measure of the pain and many of the negative consequences on functioning and aspects of health-related quality of life of a chronic pain-in-the-neck.

1 Inaccurate translations of original text of questionnaires

Translation of a well functioning questionnaire to another language can easily lead to nuances of meanings of statements and questions, so that the questionnaire may assess something different from what it was intended to do in the original language version.

2 Different cultures may cause misunderstandings

In addition to different nuances in meanings of translated words, cultural differences between countries may change the meaning of a question and the answer given [3]. Although a version of the NPI translated to Norwegian has been in use for several years [4], it has not been tested for reliability and responsiveness to changes in neck pain and its consequences for the patient. Therefore, this validation-study by Johansen and his co-workers of the Norwegian NPI is important [1].

3 Reliability of the Norwegian version is good in a test-retest test

Johansen and co-workers studied patients with chronic neck pain. They started by invited 600 patients referred to their Neck and Back outpatient clinic at Oslo University Hospital, and they were able to do the reliability test, i.e. measuring the same patients twice a few days apart so that the situation for the patient could not have changed much. They found that the reliability of the Norwegian version of the NPI in this test-retest of 42 patients is very good.

4 The Norwegian NPI is sensitive to clinically important changes in a neck-pain condition

The NDI measures ten items that are of clinical importance in patients with neck pain, each item measured on a scale of 0–5 (no disability, 0, total disability, 5), total disability in all ten items will give a NPI-index of 50. The ten items are painintensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and leisure activities. They were able to follow 113 patients with already a chronic pain condition for two more years in order to evaluate the sensitivity of the NDI in measuring improvement, deterioration, or no change in the neck-pain situation. Again, Johansen and co-workers were able to document that the Norwegian NPI could measure clinically important worsening or improvement in 30% each of the 113 patients [1]. They could even document that a change of only 8 points (in a scale with 50 points total) was the minimum clinically important difference (MCID), a mere 16.6% change from baseline [1].

5 Minimum detectable change (MDC) and Cronbach’s alfa

In the statistical methods used, they have calculated other important aspects of the outcomes of a survey of chronic neck-pain patients using the Norwegian NPI, such as minimum detectable change (MDC), intraclass correlation coefficient (ICC) and Cronbach’s alpha for internal consistency. All calculated variables came up with the best possible values for the Norwegian version of the neck disability index NDI).

6 Conclusions

Clinical researchers and clinicians managing patients with chronic neck pain conditions can trust their data when using the Norwegian translation of the Neck Disability Index. I congratulate Jan Borre Joahnsen and his coworkers at the Neck and Back outpatient clinic at Oslo University Hospital for succeeding so well with this much needed validation of the Norwegian version of the NPI.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2013.10.001.

Department of Pain Management and Research, Oslo University Hospital, Rikshospitalet, PO Box 4950, Nydalen, 0424 Oslo, Norway. Tel.: +47 23073691; fax: +47 23073690

  1. Conflict of interest: The author has no conflict of interest concerning this editorial comment.

References

[1] Johansen JB, Roe C, Bakke E, Mengshoel AM, Andelic A. Reliability and responsiveness of the Norwegian version of the Neck Disability Index. Scand J Pain 2014;5:28–33.Search in Google Scholar

[2] Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–15.Search in Google Scholar

[3] Schellingerhout JM, Heymans MW, Verhagen AP, de Vet HC, Koes BW, Terwee CB. Measurement properties of translated versions of neck-specific questionnaires: a systematic review. BMC Med Res Methodol 2011;11:87.Search in Google Scholar

[4] Kaale BR, Krakenes J, Albrektsen G, Wester K. Whiplash-associated disorders impairment rating: Neck Disability Index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma 2005;22:466–75.Search in Google Scholar
Published Online: 2014-01-01
Published in Print: 2014-01-01

© 2013 Scandinavian Association for the Study of Pain

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. High risk of depression and suicide attempt among chronic pain patients: Always explore catastrophizing and suicide thoughts when evaluating chronic pain patients
  5. Clinical pain research
  6. Suicide attempts in chronic pain patients. A register-based study
  7. Editorial comment
  8. Polymorphism in the μ-opioid receptor gene OPRM1 A118G —An example of the enigma of genetic variability behind chronic pain syndromes
  9. Original experimental
  10. A118G polymorphism in the μ-opioid receptor gene and levels of β-endorphin are associated with provoked vestibulodynia and pressure pain sensitivity
  11. Editorial comment
  12. Genital pain related to sexual activity in young women: A large group who suffer in silence
  13. Original experimental
  14. Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden
  15. Editorial comment
  16. The Norwegian version of the Neck Disability Index (NDI) is reliable and sensitive to changes in pain-intensity and consequences of pain-in-the-neck
  17. Clinical pain research
  18. Reliability and responsiveness of the Norwegian version of the Neck Disability Index
  19. Editorial comment
  20. Quality of life in low back pain patients with MRI-lesions in spinal bone marrow and vertebral endplates (Modic-changes): Clinical significance for outcome of spinal surgery?
  21. Clinical pain research
  22. Association of Modic changes with health-related quality of life among patients referred to spine surgery
  23. Editorial comment
  24. Warming and alkalinisation of lidocaine with epinephrine mixture: Some useful aspects at first glance, but not so simple?
  25. Clinical pain research
  26. Warmed and buffered lidocaine for pain relief during bone marrow aspiration and biopsy. A randomized and controlled trial
  28. Acknowledgement of Reviewers
https://doi.org/10.1016/j.sjpain.2013.11.002

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. High risk of depression and suicide attempt among chronic pain patients: Always explore catastrophizing and suicide thoughts when evaluating chronic pain patients
  5. Clinical pain research
  6. Suicide attempts in chronic pain patients. A register-based study
  7. Editorial comment
  8. Polymorphism in the μ-opioid receptor gene OPRM1 A118G —An example of the enigma of genetic variability behind chronic pain syndromes
  9. Original experimental
  10. A118G polymorphism in the μ-opioid receptor gene and levels of β-endorphin are associated with provoked vestibulodynia and pressure pain sensitivity
  11. Editorial comment
  12. Genital pain related to sexual activity in young women: A large group who suffer in silence
  13. Original experimental
  14. Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden
  15. Editorial comment
  16. The Norwegian version of the Neck Disability Index (NDI) is reliable and sensitive to changes in pain-intensity and consequences of pain-in-the-neck
  17. Clinical pain research
  18. Reliability and responsiveness of the Norwegian version of the Neck Disability Index
  19. Editorial comment
  20. Quality of life in low back pain patients with MRI-lesions in spinal bone marrow and vertebral endplates (Modic-changes): Clinical significance for outcome of spinal surgery?
  21. Clinical pain research
  22. Association of Modic changes with health-related quality of life among patients referred to spine surgery
  23. Editorial comment
  24. Warming and alkalinisation of lidocaine with epinephrine mixture: Some useful aspects at first glance, but not so simple?
  25. Clinical pain research
  26. Warmed and buffered lidocaine for pain relief during bone marrow aspiration and biopsy. A randomized and controlled trial
  28. Acknowledgement of Reviewers
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 29.12.2025 from https://www.degruyterbrill.com/document/doi/10.1016/j.sjpain.2013.11.002/html
Scroll to top button