Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index

Wim Jorritsma, Pieter U Dijkstra, Grietje E de Vries, Jan H B Geertzen, Michiel F Reneman, Wim Jorritsma, Pieter U Dijkstra, Grietje E de Vries, Jan H B Geertzen, Michiel F Reneman

Abstract

Purpose: To investigate relevant change on the Neck Pain and Disability Scale (NPAD) and Neck Disability Index (NDI) and which questionnaire is the most responsive in patients with non-specific chronic neck pain (CNP).

Methods: Seventy-six patients with non-specific CNP in an outpatient tertiary rehabilitation setting were dichotomized into "improved" and "stable" based on global perceived effect (GPE) scores. To investigate relevant change minimal detectable change (MDC) and minimal important change (MIC) with the receiver operator characteristic (ROC) cut-off point were assessed. Comparison of responsiveness was performed using areas under the ROC curve (AUC) and correlations between change scores of NPAD and NDI, and GPE.

Results: MDC and MIC on NPAD (scale 0-100) were 31.7 and 11.5 points, respectively. MDC and MIC on NDI (scale 0-50) were 8.4 and 3.5 points, respectively. Changes should exceed this MDC or MIC cut-off to be interpreted as relevant. AUC was 0.75 for both NPAD and NDI. Correlations between change scores of NPAD and NDI, and GPE were, respectively, 0.48 (95 % CI 0.29-0.64) and 0.49 (95 % CI 0.30-0.64).

Conclusions: Relevant change on both NPAD and NDI assessed with MDC and MIC resulted in different cut-offs and consequently with different amounts of certainty that the patient is improved. Responsiveness of NPAD and NDI was similar.

Figures

Fig. 1
Fig. 1
Receiver operator characteristic (ROC) curves of NPAD and NDI change scores
Fig. 2
Fig. 2
Distribution of NPAD-change scores in anchor-based improved and stable patients with indication of MIC at 11.5. At this point sensitivity = 0.74 and specificity = 0.70 (a). Distribution of NDI-change scores in anchor-based improved and stable patients with indication of MIC at 3.5. At this point sensitivity = 0.74 and specificity = 0.66 (b). Solid curve represents improved patients and dotted curve represents stable patients. The gray parts of the improved and stable patients represent the true positives (dark gray) and the true negatives (light gray), respectively. MDC is indicated at 31.7 for NPAD and at 8.4 for NDI

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