Neck Disability Index Questionnaire - Clinical Health Services - 2007 Page 3

NECK DISABILITY INDEX QUESTIONNAIRE

Page 3 of 3

Section 9- Sleeping

I have no trouble sleeping.

My sleep is slightly disturbed (less than 1 hour sleepless).

My sleep is mildly disturbed (1-2 hours sleepless).

My sleep is moderately disturbed (2-3 hours sleepless).

My sleep is greatly disturbed (3-5 hours sleepless).

My sleep is completely disturbed (5-7 hours sleepless).

Section 10- Recreation

I am able to engage in all of my recreational activities with no neck pain at all.

I am able to engage in all of my recreational activities with some pain in my neck.

I am able to engage in most, but not all of my recreational activities because of pain in my neck.

I am able to engage in a few of my recreational activities because of pain in my neck.

I can hardly do any recreational activities because of pain in my neck.

I cannot do any recreational activities at all.

Comments:

8/2/2007

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Parent category: Legal