9) Neck Disibility Index

Neck Disability Index

This questionnaire is designed to help us better understand how your neck pain affects your ability to manage everyday - life activities. Please mark in each section the one box that applies to you. Although you may consider that two of the statements in any one section relate to you, please mark the box that most closely describes your present - day situation
Name*

First NameLast Name
Pain Intensity*

I have no pain at the momentThe pain is very mild at the momentThe pain is moderate at the momentThe pain is fairly severe at the momentThe pain is very severe at the momentThe pain is the worst imaginable at the moment
Personal Care*

I can look after myself normally without causing extra painI can look after myself normally, but it causes extra painIt is painful to look after myself, and I am slow and carefulI need some help but manage most of my personal careI need help every day in most aspects of self careI do not get dressed. I wash with difficulty and stay in bed
Lifting*

I can lift heavy weights without causing extra painI can lift heavy weights, but it gives me extra painPain prevents me from lifting heavy weights off the floor but I can manage if items are conveniently positioned, ie. on a tablePain prevents me from lifting heavy weights, but Ican manage light weights if they are conveniently positionedI can lift only very light weightsI cannot lift or carry anything at all
Reading*

I can read as much as I want with no neck painI can read as much as I want with slight neck painI can read as much as I want with moderate neck painI can't read as much as I want because of moderate neck painI can't read as much as I want because of severe neck painI can't read at all
Headaches*

I have no headaches at allI have slight headaches that come infrequentlyI have moderate headaches that come infrequentlyI have moderate headaches that come frequentlyI have severe headaches that come frequentlyI have headaches almost all the time
Concentration*

I can concentrate fully without difficultyI can concentrate fully with slight difficultyI have a fair degree of difficulty concentratingI have a lot of difficulty concentratingI have a great deal of difficulty concentratingI can't concentrate at all
Work*

I can do as much work as I wantI can only do my usual work, but no moreI can do most of my usual work, but no moreI can't do my usual workI can hardly do any work at allI can't do any work at all
Driving*

I can drive my car without neck painI can drive as long as I want with slight neck painI can drive as long as I want with moderate neck painI can't drive as long as I want because of moderate neck painI can hardly drive at all because of severe neck painI can't drive my car at all because of neck pain
Sleeping*

I have no trouble sleepingMy sleep is slightly disturbed for less than 1 hourMy sleep is mildly disturbed for up to 1-2 hoursMy sleep is moderately disturbed for up to 2-3 hoursMy sleep is greatly disturbed for up to 3-5 hoursMy sleep is completely disturbed for up to 5-7 hours
Recreation*

I have no neck pain during all recreational activitiesI have some neck pain with all recreational activitiesI have some neck pain with a few recreational activitiesI have neck pain with most recreational activitiesI can hardly do recreational activities due to neck painI can't do any recreational activities due to neck pain
Calculation
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Neck Disability Index