Responsiveness of the German version of the Neck Disability Index in chronic neck pain patients: a prospective cohort study with a seven-week follow-up

Anke Langenfeld, Antonia Pia Gassner, Brigitte Wirth, Malin Beth Mühlemann, Luana Nyirö, Caroline Bastiaenen, Jaap Swanenburg, Anke Langenfeld, Antonia Pia Gassner, Brigitte Wirth, Malin Beth Mühlemann, Luana Nyirö, Caroline Bastiaenen, Jaap Swanenburg

Abstract

Background: The need for an efficient and feasible strategy to deal with neck pain has a high priority for many countries. Validated assessment tools like the Neck Disability Index (NDI) to evaluate the functional status of a neck pain patient are urgently needed to treat and to follow-up patients purposefully. A German version (NDI-G) was shown to be valid and reliable, but has so far not been tested for responsiveness. The aim of this study was to evaluate the NDI-G`s responsiveness.

Methods: This was a prospective cohort study with a seven-week follow-up. Fifty chronic neck pain patients filled out NDI-G twice. Additionally, the Patients' Global Impression of Change score (PGIC) was assessed at follow-up. Wilcoxon and Spearman tests were used to assess direction and strength of the association between the change in NDI-G and PGIC. The receiver operating characteristics method and the area under the curve (AUC) were calculated to assess sensitivity and specificity of the NDI-G change over time.

Results: The Wilcoxon test showed statistically significant differences for NDI-G at baseline and follow-up in the total sample, the "clinically improved" and "clinically not improved" subgroups as indicated in the PGIC. Spearman test resulted in a moderate correlation between the NDI-G and the PGIC (rS = -0.53, p = 0.01) at follow-up. AUC showed an acceptable discrimination [AUC = 0.78 (95% confidence interval 0.64 - 0.91)] of the NDI-G, with a cutoff score of 1.5, between clinically improved and clinically not improved patients, based on the PGIC.

Conclusions: The NDI-G is responsive to change in chronic neck pain. Together with the results of a previous study on its validity and reliability, the NDI-G can be recommended for research and clinical settings in patients with neck pain in German speaking countries.

Trial registration: NCT02676141. February 8, 2016.

Keywords: Chronic neck pain; German version of the Neck Disability Index; Responsiveness.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Scatterplot of NDI-G change score from first to second visit and patients` global impression of change scale (1 = much better, 2 = better, 3 = somewhat better, 4 = no change, 5 = somewhat worse, 6 = worse, 7 = much worse)
Fig. 2
Fig. 2
Receiver operating characteristics curve (ROC) of the NDI-G change scores, “clinically improved” and “clinically not improved” patients as indicated in the patient`s global impression of change scale. The area under the curve (AUC) is 0.78

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