Scribd
Upload
35 views1 page

Neck Disability Index

Uploaded by

Marccello 'Pasquale Pagano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
35 views1 page

Neck Disability Index

Uploaded by

Marccello 'Pasquale Pagano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

NECK DISABILITY INDEX

Name:_____________________________________________________ Date:________________________

Please read:
This questionnaire has been designed to give your therapist information as to how your neck pain has affected
you in your everyday life activities. Please answer each section, marking only ONE box which best describes
your status today.

Section 1— Pain Intensity Section 6— Concentration


□ I have no pain at the moment □ I can concentrate fully when I want to with no difficulty
□ The pain is very mild at the moment □ I can concentrate fully when I want to with slight difficulty
□ The pain is moderate at the moment □ I have a fair degree of difficulty in concentrating when I want to
□ The pain is fairly severe at the moment □ I have a lot of difficulty in concentrating when I want to
□ The pain is very severe at the moment □ I have a great deal of difficulty in concentrating when I want to
□ The pain is the worst imaginable at the moment □ I cannot concentrate at all

Section 2— Personal Care (washing, dressing, etc.) Section 7— Work


□ I can look after myself normally without causing extra pain □ I can do as much as I want to
□ I can look after myself normally but it causes extra pain □ I can only do my usual work but no more
□ It is painful to look after myself and I am slow and careful □ I can do most of my usual work, but no more
□ I need some help but manage most of my personal care □ I cannot do my usual work
□ I need help every day in most aspects of self care □ I can hardly do any work at all
□ I do not get dressed, wash with difficulty, and stay in bed □ I can’t do any work at all

Section 3— Lifting Section 8— Driving


□ I can lift heavy weights without extra pain □ I can drive my car without any neck pain
□ I can lift heavy weights but it causes extra pain □ I can drive my car as long as I want with slight pain in my neck
□ Pain prevents me from lifting heavy weights off the floor, but I □ I can drive my car as long as I want with moderate pain in my
can manage if they are conveniently positioned, i.e. on a table
neck
□ Pain prevents me from lifting heavy weights but I can manage
□ I can’t drive my car as long as I want because of moderate pain
light to medium weights if they are conveniently positioned
□ I can lift only very light weights in my neck
□ I cannot lift or carry anything at all □ I can hardly drive at all because of severe pain in my neck
□ I can’t drive my car at all
Section 4— Reading
□ I can read as much as I want to with no pain in my neck
Section 9— Sleeping
□ I can read as much as I want to with slight pain in my neck □ I have no trouble sleeping
□ I can read as much as I want with moderate pain in my neck □ My sleep is slightly disturbed (less than 1 hour sleep loss)
□ I can’t read as much as I want because of moderate pain in my □ My sleep is mildly disturbed (1-2 hours sleep loss)
neck □ My sleep is moderately disturbed (2-3 hours sleep loss)
□ I can hardly read at all because of severe pain in my neck □ My sleep is greatly disturbed (3-5 hours sleep loss)
□ I cannot read at all □ My sleep is completely disturbed (5-7 hours sleep loss)

Section 5— Headache Section 10— Recreation


□ I have no headache at all □ I am able to engage in all my recreational activities with no neck
□ I have slight headaches which come infrequently pain at all
□ I have moderate headaches which come infrequently □ I am able to engage in all my recreational activities with some
□ I have moderate headaches which come frequently pain in my neck
□ I have severe headaches which come frequently □ I am able to engage in most but not all of my recreational
□ I have headaches almost all the time activities because of pain in my neck
□ I am able to engage in a few of my recreational activities because
of pain in my neck
□ I can hardly do any recreational activities because of pain in my
neck
□ I can’t do any recreational activities at all

You might also like