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Neck Disability Index

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Neck Disability Index

Patient Name:

_______________________

Date: _______________________

This Neck Disability Index questionnaire is designed to help us understand how your neck pain affects

your ability to perform everyday activities. Please answer each section by marking the ONE choice that

MOST applies to you. You may feel that more than one statement may relate to you, but please only

choose the choice which describes you the MOST.

Pain Intensity

 I have no pain at the moment

 The pain is very mild at the moment

 The pain is moderate at the moment

 The pain is fairly severe at the moment

 The pain is very severe at the moment

 The pain is the worst imaginable at the moment

Lifting

 I can lift heavy weight without extra pain

 I can lift heavy weight, but it causes extra pain

Pain prevents me from lifting heavy weight off the floor, but I can manage if they are conveniently



positioned (i.e. on a table)

Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are



conveniently positioned

 I can lift very light weights

 I cannot lift or carry anything at all

Headaches

I have no headaches at all

 I have slight headaches which come occasionally

 I have moderate headaches which come occasionally

 I have moderate headaches which frequently

 I have severe headaches which come frequently

 I have headaches almost all the time

Personal Care

 I can care for myself without causing extra pain

 I can care for myself normally but it causes extra pain

 It is painful to care for myself and I am slow and careful

 I need some help but manage most of my personal care

 I need help every day in most aspects of personal care

 I do not get dressed; I wash with difficulty and stay in bed

Reading

 I can read as much as I want with no pain in my neck

 I can read as much as I want with slight pain in my neck

 I can read as much as I want with moderate pain in my neck

 I can’t read as much as I want because of moderate pain in my neck

 I can hardly read at all because of severe pain in my neck

 I cannot read at all

Neck Disability Index

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