Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain



      This study compares the sensitivity to change of the Neck Disability Index (NDI) and the Neck Bournemouth Questionnaire (NBQ) in patients with chronic uncomplicated neck pain.


      This prospective longitudinal study was completed in an outpatient physical therapy clinic. Subjects, with uncomplicated neck pain (no concurrent shoulder pain or nerve root symptoms) for more than a 3-month duration, participated in a 4-week course of therapy that included moist heat, neck exercises, and either mobilization or massage. Outcome measures included standardized response means (sensitivity to change), Cronbach α (internal consistency), and 2-way Spearman correlations between the 2 questionnaires and between a pain Visual Analog Scale and each questionnaire (convergent validity).


      Mean (SD) score change of the NDI was 6.22 (5.12), and of the NBQ, 14.00 (11.99). Standardized response means were 1.21 and 1.17, respectively. Both questionnaires were more sensitive to change than the pain Visual Analog Scale (0.68). There was moderate correlation between the change scores of all 3 outcome tools (Spearman 0.46-0.57). The NBQ had higher internal consistency than the NDI.


      The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain. Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain. Both had acceptable internal consistency and are appropriate for use as single-outcome scales.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Borghouts JA
        • Koes BW
        • Vondeling H
        • Bouter LM
        Cost-of-illness of neck pain in The Netherlands in 1996.
        Pain. 1999; 80: 629-636
        • Cote P
        • Cassidy JD
        • Carroll LJ
        • Kristman V
        The annual incidence and course of neck pain in the general population: a population-based cohort study.
        Pain. 2004; 112: 267-273
        • Bovim G
        • Schrader H
        • Sand T
        Neck pain in the general population.
        Spine. 1994; 19: 1307-1309
        • Guez M
        • Hildingsson C
        • Nilsson M
        • Toolanen G
        The prevalence of neck pain: a population-based study from northern Sweden.
        Acta Orthop Scand. 2002; 73: 455-459
        • Shekelle PG
        • Coulter I
        Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel.
        J Spinal Disord. 1997; 10: 223-228
        • Hoving JL
        • O'Leary EF
        • Niere KR
        • Green S
        • Buchbinder R
        Validity of the neck disability index, Northwick Park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders.
        Pain. 2003; 102: 273-281
        • Vernon H
        • Mior S
        The neck disability index: a study of reliability and validity.
        J Manipulative Physiol Ther. 1991; 14: 409-415
        • Riddle DL
        • Stratford PW
        Use of generic versus region-specific functional status measures on patients with cervical spine disorders.
        Phys Ther. 1998; 78: 951-963
        • Hains F
        • Waalen J
        • Mior S
        Psychometric properties of the Neck Disability Index.
        J Manipulative Physiol Ther. 1998; 21: 75-80
        • Bolton JE
        • Breen AC
        The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients.
        J Manipulative Physiol Ther. 1999; 22: 503-510
        • Bolton JE
        • Humphreys BK
        The Bournemouth Questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients.
        J Manipulative Physiol Ther. 2002; 25: 141-148
        • Katz JN
        • Larson MG
        • Phillips CB
        • Fossel AH
        • Liang MH
        Comparative measurement sensitivity of short and longer health status instruments.
        Med Care. 1992; 30: 917-925
        • Kazis LE
        • Anderson JJ
        • Meenan RF
        Effect sizes for interpreting changes in health status.
        Med Care. 1989; : 27
        • Cohen J
        Statistical power analysis for the behavioral sciences.
        2nd ed. Lawrence Earlbaum Associates, Hillsdale, (NJ)1988
        • Stratford PW
        • Riddle DL
        Assessing sensitivity to change: choosing the appropriate change coefficient.
        Health Qual Life Outcomes. 2005; 3: 23
        • Kjellman GV
        • Skargren EI
        • Oberg BE
        A critical analysis of randomised clinical trials on neck pain and treatment efficacy. A review of the literature.
        Scand J Rehabil Med. 1999; 31: 139-152
        • Aker PD
        • Gross AR
        • Goldsmith CH
        • Peloso P
        Conservative management of mechanical neck pain: systematic overview and meta-analysis.
        BMJ. 1996; 313: 1291-1296
        • Beaton DE
        • Bombardier C
        • Katz JN
        • Wright JG
        A taxonomy for responsiveness.
        J Clin Epidemiol. 2001; 54: 1204-1217
        • Beaton DE
        • Tarasuk V
        • Katz JN
        • Wright JG
        • Bombardier C
        “Are you better?” A qualitative study of the meaning of recovery.
        Arthritis Rheum. 2001; 45: 270-279
        • Streiner DL
        Starting at the beginning: an introduction to coefficient alpha and internal consistency.
        J Pers Assess. 2003; 80: 99-103
        • Hurst H
        • Bolton J
        Assessing the clinical significance of change scores recorded on subjective outcome measures.
        J Manipulative Physiol Ther. 2004; 27: 26-35
        • Amadio PC
        • Silverstein MD
        • Ilstrup DM
        • Schleck CD
        • Jensen LM
        Outcome after Colles fracture: the relative responsiveness of three questionnaires and physical examination measures.
        J Hand Surg [Am]. 1996; 21: 781-787
        • Perillo M
        • Bulbulian R
        Responsiveness of the Bournemouth and Oswestry questionnaires: a prospective pilot study.
        J Manipulative Physiol Ther. 2003; 26: 77-86