The NDI demonstrates a two factor structure in the whiplash-associated disorder population. Cultural factors should be considered when selecting the NDI as a primary outcome measure. This may be due to the fact that driving is restricted to certain genders in certain cultures. Missing data for driving (item 8) occurs with a high frequency. The change in NDI score at which a cervical spine fusion patient will perceive a marked improvement, compared to before surgery, is a 10 point decrease. This suggests the NDI may be an incomplete primary outcome measure in the whiplash-associated disorder population. Several relevant items, such as social and emotional items, of whiplash-associated disorders are out of the scope of the NDI.
(Hoving et al, 2003, Neito et al, 2008, Chan Ci En et al, 2009) Medication use is not addressed by the NDI, which suggests the NDI may be an incomplete primary outcome measure. Medication use can have an impact on the scoring of the different items of the NDI and also on the interpretation of the score. These components are not addressed by the NDI, which suggests the NDI may be an incomplete primary outcome measure. Sports and computer work are important aspects to consider in regards to the modern disablement process of neck pain. Thus, the use of MDC over the MIC increases the certainty that the observed change score is relevant and larger than measurement error. Of the two options, application of the MDC is the more conservative choice. Utility scores derived from the NDI may be useful in making cost-effective choices in guiding evidence based care among and between healthcare disciplines.Ĭlinicians should be aware that choosing either the minimal detectable change (MDC) or the minimal important change (MIC) gives different cut-off values and amounts of certainty on whether the observed change is relevant in patients with non-specific neck pain of duration greater than 3 months. Translational healthcare economic models demonstrate that NDI scores are predictive of SF-6D utility scores in patients receiving either a total disc arthroplasty or anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease involving one vertebral level between C3 and C7. Consider NDI changes of 10 points to be clinically meaningful for patients presenting with mechanical neck pain both with and without concurrent UE symptoms.Ĭonsider NDI changes of 13 points to be clinically meaningful for patients presenting with cervical radiculopathy.
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