Cross-cultural Adaptation, Reliability, Validity, and Responsiveness of the Simplified-Chinese Version of Neck Disability Index

The Predictive Value and Influencing Factors of Craniocervical Flexion Test for Patients with Chronic Non-Specific Neck Pain: A Case Control Study

Purpose

This study aims to examine the predictive value of Craniocervical Flexion Test (CCFT) scores in individuals with chronic non-specific neck pain (CNNP) and to identify factors that may affect CCFT scores.

Methods

This case-control study included 73 patients with CNNP and 127 healthy controls. We assessed baseline information such as demographics, duration and frequency of CNNP onset, Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores. All subjects were evaluated by the same rater for CCFT, maximal muscle strength, and endurance of the deep cervical flexors. Head and neck posture was measured using two-dimensional videography, capturing sagittal head angle (SHA), forward head angle (FHA), and protracted shoulder angle (PSA). The predictive capacity of CCFT for CNNP was evaluated using the ROC curve and area under the curve (AUC). Univariate and multivariate ordered logistic regression models were employed to analyze factors influencing CCFT scores.

Results

The final analysis included 70 participants in the CNNP group and 123 in the control group. The CNNP group demonstrated lower CCFT scores, reduced maximal muscle strength, and decreased endurance of the deep cervical muscles (P<0.05). Among maximum muscle strength, endurance, and CCFT scores, the latter exhibited the highest AUC. Univariate and multivariate ordered logistic regression analyses revealed that maximal muscle strength, muscle endurance, FHA, and lower NDI scores significantly increased the likelihood of higher CCFT scores (P<0.05), while SHA significantly decreased this likelihood (P<0.05).

Conclusion

CCFT demonstrates good predictive value for CNNP, surpassing muscle strength and endurance. Maximal muscle strength, muscle endurance, FHA, and lower NDI scores were positive influencing factors for CCFT scores, whereas SHA was a negatively influencing factor.

Psychometric properties of neck disability index - a systematic review and meta-analysis

PURPOSE

To evaluate the data on the psychometric properties of the Neck Disability Index (NDI).

MATERIALS AND METHODS

Medline, Embase, PsychINFO, Web of Science, and Scopus were searched in April 2023. The random effects meta-analysis was conducted when possible.

RESULTS

Of 492 identified records, 79 were included. 70 studies were considered to be of low risk of systematic bias. Alpha was >0.81. Pooled test-retest intraclass correlation coefficient was 0.91 (95% CI 0.90-0.93). The NDI correlations with pain rating scales varied from 0.38 to 0.89. 13 studies found the NDI to be unidimensional and 15 - two- or three-dimensional. The minimal detectable change varied from 3% to 27% and minimal clinically important difference from 5% to 33%. Pooled area under the curve was 0.74 (95% CI 0.68-0.80). Most studies have not detected floor or ceiling effect. Sex-related differential item functioning has been present in one study.

CONCLUSIONS

The NDI demonstrated good internal consistency and test-retest reliability without floor or ceiling effect. In most situations, the NDI could be considered a unidimensional scale. The NDI well correlated with the common scales of pain and disability. The minimal clinically important difference and minimal detectable change were around 15% (7.5/50 points).

Are cervical curvature and axioscapular muscle activity associated with disability in patients with chronic nonspecific neck pain? - a cross sectional exploratory study

Purpose

To ascertain the relationship between cervical curvature, neck muscle activity and neck disability in patients with chronic nonspecific neck pain (CNNP).

Methods

Ninety participants (mean age = 27.2, female/male ratio = 7/2) with CNNP volunteered. The Neck Disability Index was used to assess neck disability. To indicate the electromyographic characteristics of the axioscapular muscles, the root mean squares and median frequencies of upper trapezius and levator scapula were used. Cervical curvature was measured with a flexible ruler.

Results

Disability of the neck was significantly correlated with curvature (r = -0.599, p < 0.001), upper trapezius root mean square (RMS) (r = 0.694, p < 0.001) and levator RMS (r = 0.429, p < 0.05). Multiple regression analysis produced a significant predictive equation that could predict disability: 33.224- 0.515 × Curvature + 0.156 × Levator RMS - 0.059 × Upper trapezius median frequency + 0.636 × upper trapezius RMS + 0.020 × levator median frequency, with R2 = 0.622.

Conclusion

Cervical curvature as well as different axioscapular muscle activity were found to be related to level of disability. These findings have implications for clinical management of CNNP.

Comparison of Outcomes of Physical Therapy Exercises Combined with Either a Video-Based Smartphone Application System or a Written Exercise Program Handout in 34 Patients with Non-Specific Neck Pain

BACKGROUND An exercise program was developed using risk factors for non-specific neck pain. This study aimed to compare the effects video-based versus image- and text-based remote home training performed using this exercise program in patients with non-specific neck pain. MATERIAL AND METHODS Among the 37 patients with non-specific neck pain recruited, 34 patients who satisfied the inclusion criteria were enrolled in this study. The participants were randomized into the experimental (n=17) and control (n=17) groups. The patients in the experimental group performed exercises using a video-based application system, whereas those in the control group performed exercises using an image- and text-based printout. In-home training was implemented for 6 weeks in both groups. The neck pain intensity, disability index, active range of motion (aROM), forward head posture (FHP), and compensatory neck flexion were measured before and after the intervention. The within-group and between-group differences were analyzed at the end of the interventions. RESULTS Improvements in pain intensity, cervical ROM, disability index, FHP, and compensatory neck flexion were observed after in-home training in the experimental group (P.05). Between-group comparison revealed that the experimental group exhibited greater improvement in pain intensity, cervical ROM, and FHP than the control group (P<.05). CONCLUSIONS The findings of this study suggest that the video-based home exercise program improved pain intensity, aROM, neck disability index, FHP, and compensatory neck flexion in patients with non-specific neck pain.

Cross-Cultural Adaptation and Psychometric Validation of the Hindi Version of the Neck Disability Index in Patients With Chronic Neck Pain

STUDY DESIGN

Translation and psychometric testing.

OBJECTIVES

To cross-culturally adapt the Neck Disability Index (NDI) into the Hindi language, the local language of India, and to investigate the psychometric properties of the Neck Disability Index-Hindi (NDI-H) version in patients with neck pain.

SUMMARY OF BACKGROUND DATA

The NDI is the most used self-reported outcome measure for neck pain. The previous NDI-H version did not obtain advance permission from Mapi trust to translate this scale. As a result, this scale's availability is limited.

MATERIALS AND METHODS

Following established guidelines, the NDI was translated and culturally adapted into Hindi. A total of 120 chronic neck pain patients (20 for cognitive interviews and 100 for psychometric testing) participated in this study. The content validity, construct validity, internal consistency, test-retest reliability, and responsiveness of the NDI-H were all evaluated. The intraclass correlation coefficient was computed to determine test-retest reliability. Internal consistency was assessed using Cronbach α. The NDI's factor structure was investigated using principal component factor analysis. The Neck Pain and Disability Scale, Numeric Pain Rating Scale, and Anxiety and Depression scales were used to test criterion validity. The receiver operating characteristic curve analysis was used to determine the cut-off point and the area under the curve.

RESULTS

The NDI-H demonstrated good test-retest reliability (intraclass correlation coefficient = 0.92) and excellent internal consistency (Cronbach α = 0.90). The one-factor structure was revealed by the factor analysis. The NDI has a strong relationship with the Neck Pain and Disability Scale and Numeric Pain Rating Scale, as well as the Anxiety and Depression scales. The cut-point for detecting a change was 9.3.

CONCLUSIONS

The NDI was successfully translated into Hindi in this study. The NDI-H is a reliable and valid and responsive instrument that can be used to treat patients with chronic neck pain in clinical and research settings.

Cervical Spine Instability Screening Tool Thai Version: Assessment of Convergent Validity and Rater Reliability

Neck pain, dizziness, difficulty supporting the head for an extended period, and impaired movement are all symptoms of cervical spine instability, which may produce cervical spondylolisthesis in patients who have more severe symptoms. To avoid problems and consequences, early detection of cervical spine instability is required. A previous study created a Thai-language version of a cervical spine instability screening tool, named the CSI-TH, and evaluated its content validity. However, other characteristics of the CSI-TH still needed to be evaluated. The objective of the current study was to assess the rater reliability and convergent validity of the CSI-TH. A total of 160 participants with nonspecific chronic neck pain were included in the study. The Neck Disability Index Thai version (NDI-TH), the Visual Analog Scale Thai version (VAS-TH), and the Modified STarT Back Screening Tool Thai version (mSBST-TH) were used to evaluate the convergent validity of the CSI-TH. To determine inter- and intra-rater reliabilities, novice and experienced physical therapists were involved. The results showed that rater reliabilities were excellent: the intra-rater reliability was 0.992 (95% CI = 0.989 ± 0.994), and the inter-rater reliability was 0.987 (95% CI = 0.983 ± 0.991). The convergent validities of the VAS-TH, NDI-TH, and mSBST-TH when compared with the CSI-TH were 0.5446, 0.5545, and 0.5136, respectively (p < 0.01). The CSI-TH was developed for use by physical therapists and is reliable. It can be used by physical therapists, whether they are experienced or novices, and has an acceptable correlation to other neck-related questionnaires. The CSI-TH is concise, suitable for clinical use, and lower-priced when compared to the gold standard in diagnosis for patients with cervical spine instability.

Psychometric validation of the simplified Chinese Copenhagen Neck Functional Disability Scale in patients with chronic nonspecific neck pain

INTRODUCTION

Reliable and valid measurement tools are crucial for clinical practice in chronic nonspecific neck pain (CNSNP). The Copenhagen Neck Functional Disability Scale (CNFDS) is a widely used scale in neck pain assessment and has its unique advantages, but it is not available for patients with CNSNP in southern China.

OBJECTIVE

To develop the simplified Chinese version of CNFDS (CNFDS-SC) cross-culturally and to investigate its measurement properties in patients with CNSNP.

DESIGN

Cross-sectional study.

SETTING

Validation of neck pain measurement scale in southern China.

PATIENTS

One hundred five patients with CNSNP.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Internal consistency and test-retest reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity and structural validity were validated by hypothesis testing and exploratory factor analysis, respectively. Internal and external responsiveness were validated. Interpretability was revealed by the standard error of measurement (SEM) and smallest detectable change (SDC).

RESULTS

Internal consistency (Cronbach's alpha = 0.77 for first test and 0.84 for retest) and test-retest reliability (ICC = 0.95) were satisfactory. CNFDS-SC scores showed strong correlations with the numeric rating scale (NRS), the Neck Disability Index (NDI), and the Northwick Park Neck Pain Questionnaire (NPQ) scores (r = 0.652, 0.763, and 0.719, respectively; p < .001). Factor analysis revealed a one-factor structure of the scale. Regarding responsiveness, the standardized response mean (SRM) and the Guyatt's responsiveness index (GRI) were 1.29 and 2.12, respectively. CNFDS-SC change scores showed good correlations with the anchoring question (r = 0.619, p < .001), NDI (r = 0.439, p = .001), and NPQ (r = 0.438 p = .001) change scores; the area under the receiver-operating characteristic (ROC) curve was 0.89 (p < .001). The SEM and SDC were 0.93 and 2.57, respectively. No floor or ceiling effect and no missing items were observed.

CONCLUSION

The CNFDS-SC was demonstrated with adequate reliability, validity, responsiveness, and interpretability. The CNFDS-SC could be an effective tool for the clinical assessment of patients with CNSNP in southern China.

Ultrasound-guided pulsed radiofrequency versus dry needling for pain management in chronic neck and shoulder myofascial pain syndrome patients at a tertiary hospital in China: a randomised controlled trial protocol

INTRODUCTION

Myofascial pain syndrome (MPS), especially in the neck and shoulder region, is one of the most common chronic pain disorders worldwide. Dry needling (DN) and pulsed radiofrequency (PRF) are the two effective methods for treating MPS. We aimed to compare the effects of DN and PRF in chronic neck and shoulder MPS patients.

METHODS AND ANALYSIS

This is a prospective, single-centre, randomised, controlled trial in a tertiary hospital. We plan to recruit 108 patients aged 18-70 years who are diagnosed with chronic MPS in the neck, shoulder and upper back regions and randomly allocate them to either the DN or PRF group at a 1:1 ratio. The DN group will receive ultrasound-guided intramuscular and interfascial DN 8-10 times per pain point or until local twitch responses are no longer elicited and 30 min of indwelling. The PRF group will receive ultrasound-guided intramuscular (0.9% saline 2 mL, 42℃, 2 Hz, 2 min) and interfascial (0.9% saline 5 mL, 42℃, 2 Hz, 2 min) PRF. Follow-up will be performed by the research assistant at 0, 1, 3 and 6 months postoperatively. The primary outcome is the postoperative 6-month pain visual analogue score (0-100 mm). Secondary outcomes include pressure pain threshold measured by an algometer, Neck Disability Index, depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), sleep status (Likert scale) and overall quality of life (36-Item Short Form Survey). Between-group comparisons will be analysed using either a non-parametric test or a mixed effects linear model.

ETHICS AND DISSEMINATION

This study was approved by the medical ethics committee of Peking Union Medical College Hospital (JS-3399). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals.

TRIAL REGISTRATION NUMBER

NCT05637047, Pre-results.

Cross-cultural adaptation, reliability and validity tests of the Chinese version of the Profile Fitness Mapping neck questionnaire

OBJECTIVE

To translate and culturally adapt the Profile Fitness Mapping neck questionnaire (ProFitMap-neck) into the Chinese version and evaluate its psychometric properties.

METHODS

The procedure of translation and cross-cultural adaptation was performed according to the recommended guidelines. A total of 220 patients with chronic neck pain (CNP) and 100 individuals without neck pain participated in the study. Internal consistency, test-retest reliability, content validity and construct validity were investigated.

RESULTS

The Chinese version of ProFitMap-neck (CHN-ProFitMap-neck) showed adequate internal consistency (Cronbach's α = 0.88-0.95). A good test-retest reliability was proven by the intraclass correlation coefficient (ICC_3A,1 = 0.78-0.86). Floor-ceiling effects were absent. Exploratory factor analysis revealed 6 factors for the symptom scale and 4 factors for the function scale. The CHN-ProFitMap-neck showed a moderate to high negative correlation with NDI (r = 0.46-0.60, P < 0.01), a small to moderate negative correlation with VAS (r = 0.29-0.36, P < 0.01), and a small to high positive correlation with SF-36 (r = 0.21-0.52, P < 0.01). No significant correlation between the CHN-ProFitMap-neck function scale and VAS (P > 0.05) or the mental health domain of the SF-36 was found (P > 0.05). The CHN-ProFitMap-neck scores were significantly lower in the CNP group than in the non-CNP group (P < 0.01).

CONCLUSIONS

The CHN-ProFitMap-neck had acceptable psychometric properties and could be used as a reliable and valid instrument in the assessment of patients with chronic neck pain in mainland China.

Effect of sling exercise therapy on surface electromyography and muscle thickness of superficial cervical muscle groups in female patients with chronic neck pain

BACKGROUND

The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients.

OBJECTIVE

To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain.

METHODS

Twenty-five patients with chronic neck pain were randomly assigned to the SET group (n= 12) or the control group (n= 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test.

RESULTS

At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p< 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p< 0.05). There were no within-group differences in the control group (p> 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p< 0.05).

CONCLUSION

4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck.

Efficacy and Safety of Electro-Thumbtack Needle Therapy for Patients With Chronic Neck Pain: Protocol for a Randomized, Sham-Controlled Trial

Background

Chronic neck pain is a prevalent condition adversely impacting patients' wellbeing in both life and work experience. Electro-thumbtack needle (ETN) therapy, combining acupuncture with transcutaneous stimulation, might be one of the effective complementary and alternative medicine (CAM) therapies in treating chronic neck pain, although the evidence is scarce. This study aims to estimate the efficacy and safety of ETN therapy for chronic neck pain.

Methods and Analysis

This is a sham-controlled, randomized clinical trial. A total of 180 subjects will be randomly allocated to either the ETN group or the sham ETN group. Treatment will be administrated three times a week for four consecutive weeks, with a 6-month follow-up. The primary outcome measure will be the Numerical Rating Scale for neck pain (NRS-NP) over a period of the 4 weeks. Secondary outcome measures include the Northwick Park Neck Pain Questionnaire (NPQ), Neck Disability Index (NDI), Patient Global Impression of Change (PGIC), patient expectation, and preference assessment. The chi-square test or Fisher's exact test will be used for proportions of participants having clinically meaningful improvement. Analysis of covariance or repeated-measures analysis of variance will be applied to examine changes in the outcome measures from baseline.

Discussions

This prospective trial will contribute to evaluating the efficacy and safety of ETN in the treatment of chronic neck pain, with an intermediate-term follow-up. This study will provide further evidence for clinical neck pain management.

Ethics and Dissemination

This trial has been approved by the Research Ethical Committee of Guang'anmen Hospital (ethical approval number: 2021-039-KY-01). Recruitment began in March 2022 and will continue until December 2023. Dissemination plans include posters, WeChat, websites, and bulletin boards in hospital and communities.

Clinical Trial Registration

This trial is registered at ClinicalTrials.gov (identifier: NCT04981171).

Croatian version of the neck disability index can distinguish between acute, chronic and no neck pain : Results of a validation study

OBJECTIVE

Longitudinal study to test the validity and reliability of the Croatian version of the neck disability index (NDI-CRO) for use in patients.

METHODS

Three groups were given NDI-CRO on two occasions, 48 h apart: acute whiplash neck injury group (n = 30), hospital physiotherapists-professional chronic neck pain group (n = 56) and control group (n = 65). To test validity, correlation between NDI-CRO and the pain VAS and PHQ‑9 questionnaire for depression was analyzed. Reliability testing was done using the test-retest experiment and item-total score correlation.

RESULTS

Test-retest showed excellent correlation in all groups: whiplash 0.86, control 0.95 and physiotherapist 0.89 (Spearman r). Item-total score in the 3 analyzed groups showed positive correlation in all 10 categories, varying from 0.43-0.85. The NDI-CRO score showed significant difference between groups (median whiplash 38%, physiotherapist 12% and control 6%, p < 0.05). Validity testing showed positive correlation between NDI and pain VAS (control r = 0.63, physiotherapist r = 0.68 and whiplash r = 0.83, p < 0.05) and PHQ‑9 (control r = 0.49, physiotherapist r = 0.71 and whiplash r = 0.69, p < 0.05). No correlation was found between NDI-CRO and age, gender or radiographic findings. In the whiplash injury group 75% of patients showed moderate to severe disability. The majority of physiotherapists showed mild to moderate disability due to neck pain while 40% showed no disability. In the control group two out of three people reported no disability.

CONCLUSION

The NDI-CRO is a valid index for measuring the degree of neck disability in people with acute and chronic neck pain and in control group. It is strongly correlated with pain VAS and PHQ‑9 index.

Less is More: Five-item Neck Disability Index to Assess Chronic Neck Pain Patients in Brazil

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

The aim of this study was to assess the structural validity of the Brazilian version of the Neck Disability Index (NDI) in patients with chronic neck pain.

SUMMARY OF BACKGROUND DATA

NDI is widely used in clinical and scientific contexts, although its structure has not been evaluated in the Brazilian version.

METHODS

Native Brazilian Portuguese speakers, aged ≥18 years, with neck pain complaint of at least 3 months, and minimal pain rating of 3 points at rest or during neck movements were included. Exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA) were used. In EFA, the adequacy of the model was assessed using Bartlett test of sphericity and Kaiser-Meyer-Olkin test. In CFA, the goodness-of-fit was assessed by the indices: root mean square error of approximation with 90% of confidence interval, comparative fit index, Tucker-Lewis Index, standardized root mean square residual, and χ2/degree of freedom. Akaike information criterion (AIC) and Bayesian information criterion (BIC) were considered to compare the models.

RESULTS

Two hundred fifty-four participants with chronic neck pain were included. The NDI model with one domain and five items presented the most adequate goodness-of-fit indexes and the lowest values of AIC and BIC, when compared with models with one domain and 10, eight, or seven items, and with the model with two domains and 10 items.

CONCLUSION

In the Brazilian context, the NDI version with one domain and five items (personal care, concentration, work, driving, and recreation) presents the best structure according to the factorial analysis.Level of Evidence: 5.

The Chinese (Mandarin) instructions of the 6-minute walk test: A validation study

Background/Objective:

To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.

Methods:

Translation was performed from the original English instruction via the recommended “Process of translation and adaptation of instruments” by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.

Results:

Intraclass correlation coefficient for inter-rater reliability was excellent (ICC=0.999, 95% confidence interval=0.996–1.000). Similarly, the intra-rater reliability across the three raters was high (R1: ICC=0.996, 95% confidence interval (CI)=0.812–1.000; R2: ICC=1.000, 95% CI=0.994–1.000; R3: ICC=1.000, 95% CI=0.998–1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption (r=0.315, p=0.023; r=0.309, p=0.026).

Conclusion:

This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.

Cross-cultural adaptation and psychometric evaluation of the Malay version of the Neck Disability Index

Purpose: Translating the Neck Disability Index (NDI) into the Malay language (NDI-M); evaluation of psychometric properties in patients with neck pain.Methods: The NDI-M was translated according to established guidelines. In the first visit, 120 participants completed the NDI-M, visual analogue scale (VAS) for pain and demographic details. 98 participants returned to complete similar questionnaires and the Global Rating of Change (GRoC) scale. The NDI-M was evaluated for internal consistency, test-retest reliability, content validity, construct validity and responsiveness.Results: The NDI-M demonstrated excellent internal consistency (Cronbach's α = 0.84) and good test-retest reliability (ICC_2,1 = 0.79). Content validity was confirmed with no floor or ceiling effects. Construct validity was established revealing three-factor subscales explaining 68% of the total variance. The NDI-M showed a moderate correlation with VAS (R_p = 0.49, p < 0.001). Regarding responsiveness, a moderate correlation between NDI-M change scores and VAS change scores was found (R_p = 0.40, p < 0.001). However, there was no significant correlation between NDI-M with GRoC (R_s = 0.11, p = 0.27).Conclusions: The NDI-M is a reliable and valid tool to measure functional outcomes in patients with neck pain. It is responsive in detecting changes in pain intensity during a patient's rehabilitation journey.Implications for rehabilitationThe NDI was translated into the Malay language and culturally adapted for Malay-speaking patients with neck pain.The NDI-M demonstrated an excellent level of internal consistency and good test-retest reliability. It demonstrated content and construct validity, with three-factor subscales, and moderate responsiveness for pain intensity.The NDI-M is a reliable, valid and responsive instrument to measure functional limitations in patients with neck pain for rehabilitation.