Neck Pain Questionnaire

 

Neck Disability Index - Vernon and Mior Cervical Spine Questionnaire
Clinician's name (or ref) Patient's name (or ref)
 
This questionnaire has been designed to give your therapist information as to how your neck pain has affected your ability to manage in everyday life.  Please answer every question by placing a mark in the box that best describes your condition today.
During the past 4 weeks......  
Section 1 - Pain Intensity   Section 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 to
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 to
The pain is the worst imaginable at the moment   I cannot concentrate at all
     
Section 2 - Personal Care (e.g., Washing, Dressing)   Section 7 - Work
I can look after myself normally without causing extra pain   I can do as much work as I want to
I can look after myself normally, but it causes extra pain   I can only do my usual work but no more
It is painful to take care of myself, and I am slow and careful   I can do most of my usual work but no more
I need some help, but I am able to manage most of my personal care   I cannot do my usual work
I need help every day in most aspects of my care   I can hardly do any work at all
I do not get dressed, I wash with difficulty, and stay in bed   I cannot do any work at all
     
Section 3 - Lifting   Section 8 - Driving
I can lift heavy weights without extra pain   I can drive my car without any neck pain
I can lift heavy weights, but it gives extra pain   I can drive my car as long as I want with slight pain in my neck
Pain prevents me from lifting heavy weights off the floor, but I can manage if the weights are conveniently positioned (e.g., on a table)   I can drive my car as long as I want with moderate pain in my neck
Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned   I cannot drive my car as long as I want because of moderate pain in my neck
I can lift only very light weights   I can hardly drive at all because of severe pain in my neck
I cannot lift or carry anything at all   I cannot drive my car at all
     
Section 4 - Reading   Section 9 - Sleeping
I can read as much as I want to with no pain in my neck   I have no trouble in sleeping
I can read as much as I want to with slight pain in my neck   My sleep is slightly disturbed (less than 1 hour sleepless)
I can read as much as I want with moderate pain in my neck   My sleep is mildly disturbed (1-2 hours sleepless)
I cannot read as much as I want because of moderate pain in my neck   My sleep is moderately disturbed (2-3 hours sleepless)
I can hardly read at all because of severe pain in my neck   My sleep is greatly disturbed (3-5 hours sleepless)
I cannot read at all   My sleep is completely disturbed (5-7 hours sleepless)
     
Section 5 - Headaches   Section 10 - Recreation
I have no headaches at all   I am able to engage in all my recreational activities with no neck pain at all
I have slight headaches which come infrequently   I am able to engage in all my recreational activities with some neck pain
I have moderate headaches which come infrequently   I am able to engage in most, but not all, of my usual recreational activities because pain in my neck
I have moderate headaches which come frequently   I am able to engage in a few of my usual recreational activities because of pain in my neck
I have severe headaches which come frequently   I can hardly do any recreational activities because of pain in my neck
I have headaches most of the time   I cannot do any recreation activities at all