Clinimetric properties of the Turkish translation of a modified neck disability index

Effects of Different Taping Techniques in Individuals with Myofascial Pain Syndrome with a Trigger Point in the Trapezius Muscle: A Sham-controlled Randomized Study

Objective

This study aimed to compare the effects of three different kinesio taping (KT) techniques in individuals with myofascial pain syndrome (MPS) who have a trigger point in the trapezius muscle.

Methods

The individuals included in our study were randomly divided into four groups: Group 1: Functional correlation technique, group 2: Fascia correlation technique, group 3: Star taping technique (STT), and group 4: Sham group. The visual analog scale was used to assess pain, cervical joint range of motion (ROM) with a universal goniometer, grip strength with a hand dynamometer, number of active trigger points by palpation, pressure-pain threshold with an algometer, quality of life with the Nottingham Health Profile and functional level with the Neck Disability index were evaluated before and after treatment.

Results

There was no difference between the groups in terms of demographic data and pre-treatment outcome measures (p>0.05). There was a significant difference in the pain score between the groups after treatment (p<0.05). A statistically significant difference was found in the cervical flexion ROM of all groups after treatment (p<0.05). In pairwise comparisons, these differences were found due to group 3 (p<0.05).

Conclusions

The three KT techniques are effective in reducing pain, increasing ROM, reducing the number of active trigger points, and increasing grip strength. Among these techniques, STT was found to be more effective in reducing pain and increasing cervical flexion ROM. KT is a method that can be used in the clinic for patients with MPS.

Effects of myofascial release technique in patients with unilateral cervical radiculopathy: A single blind-randomized clinical trial

OBJECTIVE

The aim of this study was to investigate the effectiveness of the myofascial release technique in individuals diagnosed with unilateral cervical radiculopathy.

MATERIALS AND METHODS

Thirty-four cervical radiculopathy patients were randomly assigned to either the myofascial release group or the exercise group. Both groups received conventional treatment. Additionally, the exercise group performed stretching and strengthening exercises while the myofascial release group received the myofascial release technique. The pain pressure threshold, muscle strength, cervical range of motion, pain, and disability variables were assessed for all patients.

RESULTS

The myofascial release group demonstrated significantly larger improvements in flexion (p = 0.001), extension (p = 0.037), left rotation (p = 0.012), and left lateral flexion (p = 0.001) range of motions compared to the exercise group. Muscle strength in the wrist flexors (p < 0.001), wrist extensors (p < 0.010), biceps (p < 0.001) and triceps (p < 0.001) were significantly higher in the myofascial release group compared to the exercise group. And, again, the myofascial release group demonstrated significantly larger improvements in wrist flexors (p < 0.001), wrist extensors (p < 0.001), biceps (p < 0.001), triceps (p < 0.001), pectorals (p < 0.001), subscapularis (p < 0.001), upper trapezius (p = 0.002), and the pain pressure threshold. Finally, the myofascial release group demonstrated statistically significant improvements in pain (p < 0.001) and disability (p < 0.001) scales compared to the exercise group.

CONCLUSION

Evaluation of the arm muscle strength and pain pressure threshold variables in patients with cervical radiculopathy may benefit clinicians in the preparation of treatments. Cervical radiculopathy symptoms may improve after the application of myofascial release techniques. A customized cervical exercise program and conventional treatment could be added to the non-surgical treatment of cervical radiculopathy.

Comparison of the effectiveness of dry needling and high-intensity laser therapy in the treatment of myofascial pain syndrome: a randomized single-blind controlled study

Myofascial pain syndrome (MPS) is a very common disease in the population that seriously affects quality of life. Although many treatment modalities are used, there is still no common protocol. The aim of this study was to compare the effectiveness of high-intensity laser therapy (HILT) and dry needling options. This prospective study included 108 patients with neck and/or upper back pain, diagnosed with MPS, who were randomly separated into 3 groups: the exercise group, the exercise + HILT group (HILT group), and the exercise + dry needling group (needling group). The visual analog scale (VAS), neck disability index (NDI), short form-36 (SF-36) scores, and neck range of motion (ROM) values of the patients before and after treatment were recorded and compared between the groups. In all 3 groups, the VAS and NDI scores decreased and ROM levels increased after treatment. The results in the HILT and needling groups were statistically significantly better than those of the exercise group (p < 0.05).The addition of HILT and dry needling to exercises is seen as a more successful treatment option to reduce pain in MPS. Clinical trial registration number: NCT05078333.

Demonstration of kinesio taping effect by ultrasonography in neck pain

OBJECTIVE

This study aimed to demonstrate the effectiveness of kinesio taping in nonspecific neck pain and to assess whether ultrasonographic parameters of the upper trapezius muscle can be used in the follow-up of kinesio taping treatment.

METHODS

This was a single-blind, prospective, randomized controlled trial study involving 60 participants with nonspecific neck pain. The participants were randomly assigned into two groups. Kinesio taping group (n=29) received a 4-week neck exercise program, with kinesio taping applied twice a week for a total of four times, and the exercise group (n=28) received a 4-week neck exercise program. Participants were evaluated according to pain intensity (Visual Analog Scale), cervical range of motion, and disability (Neck Disability Index). Also, trigger point diameter and upper trapezius muscle thickness were evaluated with ultrasonography. Before and after the therapy, as well as the first month, all measures were taken by an investigator other than the practitioner of the treatment program.

RESULTS

The results showed that the Visual Analog Scale and Neck Disability Index scores in the kinesio taping group were statistically significantly improved when compared to the exercise group (p<0.05). In addition, the thickness of the upper trapezius muscle and the diameter of the trapezius muscle trigger point were statistically significantly improved in the kinesio taping group compared to the exercise group (p<0.05). In the kinesio taping group, there was no statistical significance in cervical range of motion as compared to the exercise group.

CONCLUSION

The combination of kinesio taping and exercise therapy was effective in reducing nonspecific neck pain and neck disability. Also, this study showed that ultrasonographic evaluation of the trapezius muscle could be used in the follow-up of kinesio taping therapy.

Investigation of the effectiveness of neck stabilization exercises in patients with chronic neck pain: A randomized, single-blind clinical, controlled study

Objectives: This study aims to compare the efficacy of neck stabilization exercises versus a conventional exercise program on pain, range of motion, disability, and depression in patients with chronic neck pain.

Patients and methods: This prospective, single-blind, randomized controlled study included 60 patients with chronic neck pain, 58 (21 males, 37 females; mean age: 36.7±8.5 years; range, 18 to 55 years) of whom completed the study. The patients were randomized into two groups. Patients in one group were given neck stabilization exercises, while the patients in the other group were given conventional neck exercises. Neck pain due to activities of daily living (Visual Analog Scale), neck range of motion in sagittal, transverse, and frontal planes, disability (Neck Disability Index), and depression (Beck Depression Inventory) were evaluated at the beginning, at the end of the treatment, and at the first and third months after the end of treatment.

Results: Significant improvement was achieved in both groups in terms of Visual Analog Scale, Neck Disability Index, neck range of motion in the sagittal, transverse, and frontal planes, and Beck Depression Inventory compared to the beginning of treatment (p<0.05). In the stabilization exercise group, statistically significant improvement was found in the range of motion of the neck in the transverse plane (p<0.05).

Conclusion: Stabilization exercise programs, which show their effect by maintaining segmental stabilization, postural control, and balance between the superficial and deep muscles of the neck region, contribute to reduced pain in daily activities and improved function similar to conventional exercise programs.

Comparison of the efficacy of mud-pack and hot-pack treatments in chronic non-specific neck pain: A single-blind, randomized-controlled study

Objectives: This study aims to compare the short-term efficacy of mud-pack (MP) and hot-pack (HP) treatments with the same temperature and duration on sleep, function, depression, and quality of life for chronic non-specific neck pain (CNNP) patients.

Patients and methods: Between December 2018 and September 2019, a total of 70 patients with CNNP diagnosis (12 males, 58 females; mean age: 50.2±9.4 years; range, 24 to 65 years) were included. The patients were divided into two groups. The MP group (n=35) had a total of 15 sessions of MP for 20 min + transcutaneous electrical nerve stimulation (TENS) for 20 min + home exercise (HE) on five days per week for three weeks. The HP group (n=35) had 15 similar sessions of HP for 20 min + TENS for 20 min + HE. The patients were assessed with the Visual Analog Scale (VAS-pain), VAS physician’s and patient’s global assessments, modified Neck Disability Index (mNDI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36) measures before treatment, at the end of post-treatment third week and one month later.

Results: In the MP group, there were statistically significant improvements in all parameters at the end of treatment three-week and one-month follow-up (p<0.05), apart from SF-36 Vitality/Energy (SF-36V/E) at the end of treatment and SF-36 General Health (SF-36GH) at one month. In the HP group, there were statistically significant improvements observed for all parameters (p<0.05), apart from the SF-36 Physical Role and SF-36GH at the end of treatment third week and SF-36V/E at the first-month assessment. The VAS-pain(p<0.001), mNDI (p=0.019), BDI (p=0.002), SF-36GH (p<0.001), SF-36V/E (p<0.001) and SF-36 mental health (p<0.001) showed statistically significantly superior improvements in the MP group (p<0.05).

Conclusion: In CNNP patients, both MP and HP treatments are effective. However, MP therapy has more positive effects on pain, function, depression, and quality of life parameters. The MP treatment may be used in addition to TENS treatment for CNNP patients.

The assessment of affective temperament and life quality in myofascial pain syndrome patients

OBJECTIVES

Myofascial Pain Syndrome (MPS) is known as a chronic pain syndrome, which is often associated with decreased life quality, depressive, and anxiety disorders. Affective temperament characteristics are mental illness signs that may assist in anticipating and detecting a tendency to depression and anxiety in MPS. The properties and impacts of affective temperament on pain, disability, life quality, depressive, and anxiety disorders in MPS patients were intended to explore by this study.

PATIENTS AND METHODS

This case-control study was carried out in the physical medicine and rehabilitation clinic of a university hospital, Turkey, from October 2018 to January 2019 with 51 MPS patients and 47 healthy controls (HC). Physical examination, clinical history, visual analog scale (VAS), neck disability index (NDI), Short Form (36) Health Survey (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego- Autoquestionnaire (TEMPS-A) scale were performed for all volunteers.

RESULTS

TEMPS-A depressive, cyclothymic, and anxious scores were remarkably higher in MPS patients than in the HC group. In MPS patients, SF 36 physical and mental health summary scores were remarkably lower than the control group. Additionally, BDI and BAI scores were significantly higher in patients with MPS than in the control group. There was a significant positive correlation between depressive and anxious temperament scores and NDI. Moreover, a negative correlation was found between the SF36 physical health summary score and depressive and anxious temperament scores. Also, the mental health summary score was negatively correlated with depressive, cyclothymic, and anxious temperament scores.

CONCLUSION

This research assesses for the first time of the affective temperament characteristics of MPS patients.KEY POINTSMyofascial pain syndrome patients have distinct temperaments than the control group.Myofascial pain syndrome patients had remarkably higher TEMPS-A depressive, cyclothymic, and anxious scores than the healthy control group.Life quality, clinical severity, and courses can be affected by differences in temperament.Clinicians can readily apply the TEMPS-A temperament scale in patient application to demonstrate these differences.The anticipation of a psychiatric situation plays a more significant role in evaluating the higher mood symptom rates and their effect on life quality.

The Bournemouth Questionnaire for Neck Pain: Cross-cultural Adaptation, Reliability, and Validity of the Turkish Version

OBJECTIVE

The aim of this study was first to translate and culturally adapt the BQN, and then to investigate the validity and reliability of the Turkish version of the BQN in Turkish individuals with chronic neck pain.

METHODS

The English version of the BQN was translated into Turkish with permission from its authors. That translation was assessed using 85 participants with a mean age of 46.75 years who had chronic neck pain. At the same time, the participants were assessed sociodemographically and with the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD). A test-retest procedure was performed with 62 participants who underwent a second assessment with the BQN within 24 hours of the first assessment, to test its reliability.

RESULTS

Internal consistency was strong and all Cronbach alpha values were between 0.97 and 0.99. The BQN showed high test-retest reliability (intraclass correlation coefficient ˃ 0.92) for all domains. The total mean (± standard deviation) scores for the 3 questionnaires were as follows: BQN, 30.9 (± 11.18); NPAD, 48.16 (± 12.93); NDI, 17.85 (± 6.29). The results of the Turkish version of the BQN illustrated adequate external construct validity and sensitivity. A Turkish translation of the test has not previously been available for chronic pain.

CONCLUSION

The BQN was successfully translated and culturally adapted into Turkish. The reliability and validity were tested against the NPAD and the NDI. The Turkish version of the BQN is multidimensional, short, practical, and suitable for use with individuals with neck pain.

The effects of forward head posture on expiratory muscle strength in chronic neck pain patients: A cross-sectional study

Objectives

This study aims to investigate the relationship between forward head posture (FHP) and respiratory dysfunctions in patients with chronic neck pain.

Patients and methods

Between June 2014 and November 2016 , a total of 99 patients (11 males, 88 females; mean age 54.1±9 years; range, 38 to 75 years) with chronic neck pain were evaluated for head posture by cervical lateral radiograph measuring the anterior head translation distance (FHPmm) and C7 vertebrae position (C7°). We examined the chest expansion by subtracting chest circumference from the level of xiphoid during maximal inspiration and expiration. Pain severity and neck disability were assessed using the Visual Analog Scale (VAS) and modified Neck Disability Index (MNDI), respectively. The respiratory functions were evaluated using spirometry tests, lung volumes, and maximal inspiratory and expiratory pressures (Pi_max and Pe_max, respectively).

Results

There was a negative correlation between the FHPmm with Pe_max% (rho: -0.314; p=0.005). A negative correlation was also observed between C7° and Pe_max, Pe_max%, forced expiratory volume in one sec (FEV1)/forced vital capacity (FVC)%, forced expiratory flow (FEF)25-75%, and FEF75% (rho:-0.245, -0.349, -0.218, -0.214, and -0.259 respectively; p=0.028, 0.002, 0.035, 0.040, and 0.012, respectively). There was a positive correlation between neck disability and VAS scores (rho: 0.424; p<0.001), while there was a negative correlation between neck disability and chest expansion, maximum voluntary ventilation (rho: -0.201 and -0.217, respectively; p=0.049 and 0.046, respectively).

Conclusion

Based on our study results, FHP is associated with expiratory muscle weakness in chronic neck pain patients. To evaluate respiratory dysfunction, chest expansion tests may be useful, although these tests are not specific to muscle weakness. Interventions about FHP and neck pain should focus on the effects of respiratory muscle training.

Comparison of STarT Back Screening Tool and Simmonds Physical Performance Based Test Battery in Prediction of Disability Risks Among Patients with Chronic Low-Back Pain

Objectives This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction were carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results The mean age, weight, height and body mass index of the participants were 51.4 ±8.78 years, 1.61 ±0.76 m and 26.6 ±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37 ±1.37 and 21.2 ±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion The Start Back Screening Tool is able to identify the proportion of patients with low back pain with moderate disability risks, while the Simmonds Physical Performance Tests Battery is better able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance assessment based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. In contrast to SPBBT, SBST exhibited no floor or ceiling effects in our tests, and demonstrated high sensitivity but low specificity in predicting ‘high-disability risk’.

Translation, reliability, and validity of the Turkish version of the Neck Bournemouth Questionnaire

Objectives

The aim of this study was to translate the Neck Bournemouth Questionnaire into Turkish and to test the reliability and validity of the Turkish version of the Neck Bournemouth Questionnaire (BQc-t).

Patients and methods

Between June 2014 and July 2015, a total of 97 patients with neck pain (27 males, 70 females; mean age 46.6±10.6 years; range, 18 to 65 years) were included in the study. The patients underwent a physical therapy and rehabilitation program. For translation, the American Association of Orthopedic Surgeons guideline was used. The reliability was measured with internal consistency and test-retest by calculation of the Cronbach alpha and intraclass correlation coefficient (ICC) respectively. Internal construct validity of the BQc-t was analyzed with confirmatory factor analysis. For external construct validity, the correlations between the BQc-t results and the Neck Pain and Disability Scale (NPAD), Modified Neck Disability Index (MNDI), and Short Form-36 (SF-36) were analyzed before and after treatment. Responsiveness was calculated as the effect size (ES) and standardized response mean (SRM). Minimal detectable change (MDC) score was calculated to evaluate interpretability.

Results

The ICC value for test-retest of total score was 0.945. Pre- and post-treatment Cronbach alpha coefficients were 0.877 and 0.907, respectively, showing that the reliability of the BQc-t was considerably high. Confirmatory factor analysis showed that questions were found to cluster in a single dimension. In terms of the external construct validity, there was a positive statistically significant correlation between the BQc-t questions, except for Question 7, and relevant subscales of the NPAD and MNDI. There was also a negative statistically significant correlation between the BQc-t questions and SF-36 subgroups. The ES and SRM were 1.23 and 1.48, respectively. The MDC was 20.31.

Conclusion

Our study results show that the BQc-t is reliable, valid, and sensitive to clinical changes.

Urdu version of the neck disability index: a reliability and validity study

Background

Despite the wide use of the neck disability index (NDI) for assessing disability in patients with neck pain, the NDI has not yet been translated and validated in Urdu. The first purpose of the present study was to translate and cross-culturally adapt the NDI into the Urdu language (NDI-U). The second purpose was to investigate the reliability, validity and responsiveness of the NDI-U in Urdu-speaking patients experiencing chronic mechanical neck pain (CMNP).

Methods

Translation and cross-cultural adaptation of the original version of the NDI were carried out using previously described procedures. Seventy-six patients with CMNP and thirty healthy participants were recruited for the study. NDI-U and visual analogue scales for pain intensity (VAS_pain) and disability (VAS_disability) were administered to all the participants at baseline and to the patients 3 weeks after receiving physiotherapy intervention. The global rating of change scale (GROC) was also administered at this time. Test-retest reliability and internal consistency were carried out on forty-six randomly selected patients two days after they completed the NDI-U. The NDI-U was evaluated for factor analysis, content validity, construct validity (discriminative and convergent validity) and responsiveness.

Results

An intra-class correlation coefficient (ICC_2,1) revealed excellent test-retest reliability for all items (ICC_2,1 = 0.86–0.98) and total scores (ICC_2,1 = 0.99) of the NDI-U. The NDI-U was found internally consistent with a Cronbach’s alpha of 0.90 and a fair to good correlation between single items and the NDI-U total scores (r = 0.34 to 0.89). Factor analysis of the NDI-U produced two factors explaining 66.71% of the variance. Content validity was good, as no floor or ceiling effects were detected for the NDI-U total score. To determine discriminative validity, an independent t-test revealed a significant difference in the NDI-U total scores between the patients and healthy controls (P < 0.001). For convergent validity, Pearson’s correlation coefficient showed a strong correlation between NDI-U and VAS_disability (r = 0.83, P < 0.001) and a moderate correlation between NDI-U and VAS_pain (r = 0.62, P < 0.001). To measure responsiveness, an independent t-test showed a significant difference in the NDI-U change scores between the stable and the improved groups (P < 0.001). Furthermore, moderate correlations were found between the NDI-U change scores and the GROC (r = 0.50, P < 0.001), VAS_disability change scores (r = 0.58, P < 0.001) and VAS_pain change scores (r = 0.55, P < 0.001).

Conclusion

The results showed that the NDI-U is a reliable, valid and responsive questionnaire to measure disability in Urdu-speaking patients with CMNP.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1469-5) contains supplementary material, which is available to authorized users.

Patient-reported outcome measures for non-specific neck pain validated in the Italian-language: a systematic review

BACKGROUND

Patient-reported outcome measures can improve the management of patients with non-specific neck pain. The choice of measure greatly depends on its content and psychometric properties. Most questionnaires were developed for English-speaking people, and need to undergo cross-cultural validation for use in different language contexts. To help Italian clinicians select the most appropriate tool, we systematically reviewed the validated Italian-language outcome measures for non-specific neck pain, and analyzed their psychometric properties and clinical utility.

METHODS

The search was performed in MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Library. All articles published in English or Italian regarding the development, translation, or validation of patient-reported outcome measures available in the Italian language were included. Two reviewers independently selected the studies, extracted data, and assessed methodological quality using the COSMIN checklist.

RESULTS

Out of 4891articles screened, 66 were eligible. Overall, they were of poor or fair methodological quality. Four instruments measuring function and disability (Neck Disability Index, Neck Pain and Disability Scale, Neck Bournemouth Questionnaire, and Core Outcome Measures Index), and one measuring activity-related fear of movement (NeckPix©) were identified. Each scale showed some psychometric weaknesses or problems with functioning, and none emerged as a gold standard.

CONCLUSIONS

Several patient-reported outcome measures are now available for assessing Italian people with non-specific neck pain. While the Neck Disability Index is the one most widely used, the Neck Bournemouth Questionnaire appears the most promising tool from a psychometric point of view.

The Neck Disability Index-Russian Language Version (NDI-RU): A Study of Validity and Reliability

STUDY DESIGN

Cross-cultural adaptation and psychometric testing.

OBJECTIVE

To perform a validated Russian translation and then to evaluate the validity and reliability of the Russian language version of the Neck Disability Index (NDI-RU).

SUMMARY OF BACKGROUND DATA

Neck pain is highly prevalent and can greatly affect daily activity. The Neck Disability Index (NDI) is the most frequently used scale for self-rating of disability due to neck pain. Its translated versions are applied in many countries. However, the Russian language version of the NDI has not been developed yet.

METHODS

Cross-cultural adaptation of the NDI-RU was performed according to established guidelines. Then, the NDI-RU was evaluated for content validity, concurrent criterion validity, internal consistency, test-retest reliability, factor structure, and minimum detectable change.

RESULTS

Two hundred thirty-two patients took part in the study in total: 109 in validity (39.5 ± 10 yr), 123 in reliability (38.4 ± 11 yr; 80 in the test-retest phase). A culturally valid translation was achieved. NDI-RU total scores were distributed normally. Floor/ceiling effects were absent. Good values of Cronbach α were obtained for each item (from 0.80 to 0.84) and for the total NDI-RU (0.83). A 2-factor solution was found for the NDI-RU. The average interitem correlation coefficient was 0.53. Intraclass correlation coefficients for test-retest reliability coefficients ranged from 0.65 to 0.92 for different items and 0.91 for the total NDI-RU. Moderate correlation (Spearman rs = 0.62; P < 0.05) was found between the NDI-RU total score and graphic rating scalepain score. Completion of the NDI-RU takes 3.6 ± 1 minutes.

CONCLUSION

The development of a Russian language version of the Neck Disability Index resulted in a valid, reliable instrument that can be used both in clinical practice and scientific investigations.

LEVEL OF EVIDENCE

1.

A systematic review of cross-cultural adaptation of the neck disability index

STUDY DESIGN

Systematic review of cross-cultural adaptation.

OBJECTIVE

To perform a systematic review of cross-cultural adaptations of the Neck Disability Index (NDI) and to give a critical assessment to improve its translation.

SUMMARY OF BACKGROUND DATA

The NDI is used to assess functional capacity and physical activity in patients with neck pain, but the quality of its cross-cultural adaptations has not been systematically reviewed.

METHODS

PubMed, Cochrane Library, and EMBASE were searched up through 2013 to identify studies of cross-cultural NDI adaptations. Search terms were "Neck Disability Index" or "NDI" and "cross-cultur*" or "cultur*" or "valid*" or "equivalence" or "transl*." Data were extracted and study quality was assessed.

RESULTS

Twenty-four different NDI versions were identified from 14 different languages/cultures. Most reported forward and back translation and pretesting, but sample size was a problem for most studies. The Cronbach α was generally acceptable, and 13 versions met the criterion of reliability by reporting an intraclass correlation coefficient of 0.70 or more, although some versions did not reach the minimal intraclass correlation coefficient. Eleven versions tested ceiling and floor effects, but only 1 Japanese version reported a floor effect. No study reported interpretability, and none provided the minimal important change or minimal important difference.

CONCLUSION

The Arabic, Italian, and Thai versions were of higher quality than the other versions according to the overall assessment of the 3 checklists. The Catalan, Chinese, Japanese, Korean, Thai, and Turkish versions need more research according to the Quality Criteria for Psychometric Properties of Health Status Questionnaire. Pretest sample size was not large enough in most cases.

LEVEL OF EVIDENCE

1.

Cross-cultural adaptation, reliability and validity of the Turkish version of the spine functional index

Background

The Spine Functional Index (SFI) is a patient reported outcome measure with sound clinimetric properties and clinical viability for the determination of whole-spine impairment. To date, no validated Turkish version is available. The purpose of this study is to cross-culturally adapted the SFI for Turkish-speaking patients (SFI-Tk) and determine the psychometric properties of reliability, validity and factor structure in a Turkish population with spine musculoskeletal disorders.

Methods

The SFI English version was culturally adapted and translated into Turkish using a double forward and backward method according to established guidelines. Patients (n = 285, cervical = l29, lumbar = 151, cervical and lumbar region = 5, 73% female, age 45 ± 1) with spine musculoskeletal disorders completed the SFI-Tk at baseline and after a seven day period for test-retest reliability. For criterion validity the Turkish version of the Functional Rating Index (FRI) was used plus the Neck Disability Index (NDI) for cervical patients and the Oswestry Disability Index (ODI) for back patients. Additional psychometric properties were determined for internal consistency (Chronbach’s α), criterion validity and factor structure.

Results

There was a high degree of internal consistency (α = 0.85, item range 0.80-0.88) and test-retest reliability (r = 0.93, item range = 0.75-0.95). The factor analysis demonstrated a one-factor solution explaining 24.2% of total variance. Criterion validity with the ODI was high (r = 0.71, p < 0.001) while the FRI and NDI were fair (r = 0.52 and r = 0.58, respectively). The SFI-Tk showed no missing responses with the ‘half-mark’ option used in 11.75% of total responses by 77.9% of participants. Measurement error from SEM and MDC₉₀ were respectively 2.96% and 7.12%.

Conclusions

The SFI-Tk demonstrated a one-factor solution and is a reliable and valid instrument. The SFI-Tk consists of simple and easily understood wording and may be used to assess spine region musculoskeletal disorders in Turkish speaking patients.

Validation of the German version of the Neck Disability Index (NDI)

BACKGROUND

The Neck Disability Index (NDI) is the most commonly used outcome measure for neck pain. This study aimed to determine the psychometric properties of a German version of the NDI. Cross-cultural translation and psychometric testing of the NDI were performed.

METHODS

The 10-item NDI was translated into German and administered to 558 patients with chronic unspecific neck pain (Mean age 49.9 ± 11.4 years, 76% female). The factor structure and reliability of the NDI were assessed using factor analysis, Cronbach's alpha, split-half reliability (Spearman-Brown coefficient), and intra-class correlation (ICC2,1). To determine convergent validity, pain intensity (visual analog scale; VAS), pain on movement (VAS), and quality of life (Short Form 36 Health Survey Questionnaire; SF-36) were correlated with the NDI. Correlation with range of motion and sensitivity to change were also assessed in a subsample of 49 patients.

RESULTS

The mean NDI score was 32.75 ± 13.09. Factor analysis revealed a single factor that explained 39.8% of the variance. Cronbach's alpha was 0.81; Spearman-Brown coefficient was 0.80; and intra-class correlation was 0.81 (95% confidence interval = 0.78, 0.83). Significant correlations were found for pain intensity (r = 0.22, p < 0.01), pain on movement (r = 0.39, p < 0.01), quality of life (r = -0.30 to -0.45, p < 0.01), and range of motion (r = -0.34, p = 0.02). Patients who reported global improvement of health after an exercise or yoga intervention showed a higher decrease on the NDI than patients who reported no global improvement (p < 0.01).

CONCLUSIONS

The German version of the NDI has a comparable factor structure as the original version, acceptable psychometric properties, and is sensitive to change after physical activity. Neck disability is associated with other measures of neck pain.