Neck Disability Index Form

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NECK DISABILITY INDEX
Instructions: this questionnaire has been designed to give us information as to how your neck pain has affected
your ability to manage everyday life. Please answer every section and mark in each section only the ONE box
which applies to you at this time. We realize you may consider two of the statements in any section may relate to
you, but please mark the box which most closely describes your problem TODAY.
1.
PAIN INTENSITY
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
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
The pain is the worst imaginable at the moment
I cannot concentrate at all
2. PERSONAL CARE
7. WORK
I can look after myself normally without causing extra
I can do as much work as I want to
pain
I can only do my usual work, but no more
I can look after myself normally but it causes extra pain
I can do most of my usual work, but no more
It is painful to look after myself and I am slow and
I cannot do my usual work
careful
I can hardly do any work at all
I need some help but manage most of my personal care
I can’t do any work at all
I need help every day in most of my personal care
I don’t get dressed, I was with difficulty and stay in bed
3. LIFTING
8. DRIVING
I can lift heavy weights without extra pain
I can drive 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 only slight pain in my
Pain prevents me from lifting heavy weights off the
neck
floor, but I can manage if they are conveniently
I can drive my car as long as I want with moderate pain in my
positioned, for example on a table
neck
Pain prevents me from lifting heavy weights, but I can
I can’t drive my car as long as I want because of moderate pain
manage light to medium weights if they are conveniently
in my neck
positioned
I can hardly drive at all because of severe pain in my neck
I can lift very light weights
I can’t drive my car at all because of severe pain in my neck
I cannot lift or carry anything at all
4. READING
9. SLEEPING
I can read as much as I want to with no pain in my neck
I have no trouble sleeping
I can read as much as I want to with slight pain in my
My sleep is slightly disturbed (less than 1 hour sleepless)
neck
My sleep is mildly disturbed (1-2 hours sleepless)
I can read as much as I want with moderate pain in my
My sleep is moderately disturbed (2-3 hours sleepless)
neck
My sleep is greatly disturbed (3-5 hours sleepless)
I can’t read as much as I want because of moderate pain
My sleep is completely disturbed (5-7 hours sleepless)
in my neck
I can hardly read at all because of severe pain in my neck
I cannot read at all
5. HEADACHES
10. RECREATION
I have no headaches at all
I am able to engage in all my recreation 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 recreation 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 usual recreation
I have headaches almost all the time
activities because of my neck pain
I am able to engage in only a few of my usual recreation
activities because of pain in my neck
I can hardly do any recreation activities because of pain in my
neck
I can’t do any recreation activities at all because of pain in my
neck

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