Content and psychometric evaluations of questionnaires for assessing physical function in people with neck disorders: a systematic review of the literature

Figures & data

Table 1. Keywords sorted in word groups.

O (outcome)	I (intervention)	P (population)	P (population)
physical funct*	measure*	pain (not acute)	musculoskeletal
funct*	scale		neck
disability	questionnaire*		low back
	outcome measure*		back
	inventory
	evaluation
	psychometric*
	reliability
	validity

Excluded: rheumatoid arthr*, gonarthros*, gout, cancer, foot, ankle, hip, knee, elbow, wrist, clinical trial, effect*, jaw, head*, trauma*, fear avoidance, kinesiophobia.

Figure 1. Flowchart; systematic literature review process.

Table 2. Included neck questionnaires.

Cervical Spine Outcomes Questionnaire [19]

Copenhagen Neck Functional Disability Scale [20]

Neck Bournemouth Questionnaire [21]

Neck Disability Index [22]

Neck Pain and Disability Scale [23]

Neck Pain and Functional Limitation Scale [24]

Neck Functional Status Questionnaire [25]

Neck OutcOme Score [26]

Northwick Park Neck Pain Questionnaire [27]

ProFitMap Neck [28]

Table 3. ICF classification of the included neck questionnaire.

	ICF-categories
	Function and Impairment																Contextual factors
	Body functions (b)							Activity and participation (d)									Environmental factors (e)
Questionnaire	1	2	3	4	5	6	7	1	2	3	4	5	6	7	8	9	1	2	3	4	5
Cervical Spine Outcomes Questionnaire	134 152	265 280			510	640	730 760				440	520 540 550	649		845 850	910 920 930	110 130				570 580
Copenhagen Neck Functional Disability Scale	134 152 160	280						166	230		410 420 430	530 540		750 760		920 999
Neck Bournemouth Questionnaire	152 160 164	280						166			430 475	540	640		850	910 920
Neck Disability Index	134 160	280						166			430 475	599	640		859	920
Neck Pain and Disability Scale	134 152 160	280					780				410 429 450 470 475	510 540 550		750 760 770	859	920 999
Neck Pain And Functional Limitation Scale	134 152 160 164	280						110 166			410 430 489	540	620	760	859	920
Neck Functional Status Questionnaire							710				410 415 430 445	510 520	640 650			920
Neck OutcOme Score	134 152 160	240 280					710 780				415		620 630 640	750 760 770	850	920
Northwick Park Neck Pain Questionnaire	134	265 280						110 166			430 475		640		859	999
ProFitMap-neck	134 152 160	210 230 235 240 265 280		440	510 535		710 720 730 735 740 760 780				410 415 430 445 450 455	540			845

Body functions (b): b1 = mental functions, b2 = sensory functions and pain, b3 = voice and speech, b4 = cardio-vascular-, hematological-, immunological- and respiratory functions, b5 = digestive-, metabolic- and endocrine functions, b6 = gender-, urinary- and reproductive functions, b7 = neuromusculoskeletal and movement related functions. Activity and participation (d): d1 = learning and applying knowledge, d2 = general tasks and demands, d3 = communication, d4 = mobility, d5 = personal care, d6 = domestic life, d7 = Interpersonal interactions and relationships, d8 = Important areas of life, d9 = community, social and civic life. Environmental factors (e): e1 = products and technology, e2 = natural environment and human-made environmental changes, e3 = support and relationships, e4 = attitudes, e5 = services, systems and policies.

Note: If several items of a questionnaire concerned the same aspect, it was only categorized once. If an item included several aspects, all aspects were listed in the table.

Table 4. ICF codes with explanation.

b: Body functions	d: Activities and participation	e: Environmental factors
1 Mental functions 134 Sleep functions 152 Emotional functions 160 Thought functions 164 Higher-level cognitive functions2 Sensory functions and pain 210 Seeing functions 230 Hearing functions 235 Vestibular functions 240 Sensations associated with hearing and vestibular function 265 Touch function 280 Sensation of pain 4 Functions of the cardiovascular, hematological, immunological and respiratory systems 440 Respiration functions 5 Functions of the digestive, metabolic and endocrine systems 510 Ingestion functions 535 Sensations associated with the digestive system 6 Genitourinary and reproductive functions 640 Sexual functions 7 Neuromusculoskeletal and movement-related functions 710 Mobility of joint functions 720 Mobility of bone functions 730 Muscle power functions 735 Muscle tone functions 740 Muscle endurance functions 760 Control of voluntary movement functions 780 Sensations related to muscles and movement functions	1 Learning and applying knowledge 110 Watching 166 Reading 2 General tasks and demands 230 Carrying out daily routine 4 Mobility 410 Changing basic body position 415 Maintaining a body position 420 Transferring oneself 429 Changing and maintaining body position, other specified and unspecified 430 Lifting and carrying objects 440 Fine hand use 445 Hand and arm use 450 Walking 455 Moving around 470 Using transportation 475 Driving 489 Moving around using transportation, other specified and unspecified 5 Self-care 510 Washing oneself 520 Caring for body parts 530 Toileting 540 Dressing 550 Eating 599 Self-care, unspecified 6 Domestic life 620 Acquisition of goods and services 630 Preparing meals 640 Doing housework 649 Household tasks, other specified and unspecified 650 Caring for household objects 7 Interpersonal interactions and relationships 750 Informal social relationships 760 Family relationships 770 Intimate relationships 8 Major life areas 845 Acquiring, keeping, and terminating a job 850 Remunerative employment 859 Work and employment, other specified and unspecified 9 Community, social and civic life 910 Community life 920 Recreation and leisure 930 Religion and spirituality 999 Community, social, and civic life, unspecified	1 Products and technology 110 Products or substances for personal consumption 130 Products and technology for education 5 Services, systems and policies 570 Social security services, systems and policies 580 Health services, systems, and policies

Table 5. Mapping of psychometric assessment of the included questionnaires.

	Reliability			Validity
	Internal consistency	Reliability	Measurement error	Content validity	Construct validity	Criterion validity	Responsiveness	Interpretability
CSOQ	[19,29,30]	[19,30]	–	[19]	[30]	[19,29]	[19,30]	[19,29,30]
CNFDS	[20]	[20]	–	–	[31]	–	[20]	[20]
NBQ	[21,32]	[21]	[21,32]	–	[33,34]	[21,32]	[21,32,34,35]	[21,32,33]
NDI	[22,32,36–39]	[22,37,40–43]	[32,37,40–44]	[45]	[31,36,46]	[22,32,37,44,45]	[32,40–43]	[22,32,36–46]
NFSQ	[25]	–	–	[25]	[25]	–	–	[25]
NOOS	[47]	[47]	[47]	[26]	[26]	[47]	[47]	[26,47]
NPDS	[23]	[48]	–	[23,45]	[23,31]	[23,45,48]	[48]	[23,45,48]
NPFLS	[24]	–	–	[24]	–	[24]	–	–
NPNPQ	[27,49]	[27]	[49]	–	[31]	–	[27,49]	[27,49]
PFM	[28]	[28]	[28]	[28]	–	[28]	[50]	[28,50]

CSOQ: Cervical Spine Outcomes Questionnaire; CNFDS: Copenhagen Neck Functional Disability Scale; NBQ: Neck Bournemouth Questionnaire; NDI: Neck Disability Index; NFSQ: Neck Functional Status Questionnaire; NOOS: Neck OutcOme Score; NPDS: Neck Pain and Disability Scale; NPFLS: Neck Pain and Functional Limitation Scale; NPNPQ: Northwick Park Neck Pain Questionnaire; PFM: ProFitMap-neck.

Table 6. Methodological quality of the included questionnaires.

		Reliability			Validity
	Article	Internal consistency	Reliability	Measurement error	Content validity	Construct validity	Criterion validity	Responsiveness	Interpretability
CSOQ	BenDebba et al. (2002)	+	+		+		ODI – SF36 –	–	Some
	Skolasky et al. (2007)	–					NDI + SF36– ODI–		Some
	Skolasky et al. (2009)		–			+		–	Some
CNFDS	Jordan et al. (1998)	+	+					–	Some
	Pickering et al. (2011)					+
NBQ	Bolton et al. (2002)	+	–	+			NDI– CNFDS + SF36–	–	Some
	Gay et al. (2007)	+		–			NDI +	+	Some
	Bolton et al. (2004)							–
	Geri et al. (2015)	–				+			Some
	Hurst et al. (2004)							–
NDI	Vernon and Mior (1991)	+	+				MPQ +		Some
	Hains et al. (1998)	+				+			Some
	Gabel et al. (2014)					–			Some
	Riddle and Stratford (1998)			–			SF36–		Some
	Cleland et al. (2006)		–	+				–	Some
	Gay et al. (2007)	+		–			NBQ+	+	Some
	McCarthy et al. (2007)	+	+	+			SF36–		Some
	Cleland et al. (2008)		–	+				+	Some
	En et al. (2009)				–		NPDS+		Some
	van der Velde et al. (2009)	–							Some
	Young et al. (2009)		–	+				+	Some
	Young et al. (2010)		+	+				+	Some
	Hung et al. (2014)	–							Some
	Pickering et al. (2011)					+
NFSQ	Wang et al. (2015)	–			–	+			Some
NOOS	Juul et al. (2015)				+	+			Some
	Juul et al. (2016)	+	+	+			NDI + SF36+	–	Some
NPDS	Wheeler et al. (1999)	+			–	+	ODI + PDI+		Some
	Goolkasian et al. (2002)		+				NDI– PDI– ODI–	+	Some
	En et al. (2009)				–		NDI +		Some
	Pickering et al. (2011)					+
NPFLS	Leonard et al. (2009)	+			+		NBQ+
NPNPQ	Leak et al. (1994)	–	+					–	Some
	Sim et al. (2006)	+		+				–	Some
	Pickering et al. (2011)					+
PFM	Björklund et al. (2012)	+	+	+	+		NDI + SF36– SES–		Some
	Björklund et al. (2016)							+	All

+: adequate; −: not adequate. For further information, see “Quality assessment of the questionnaires” section.

CSOQ: Cervical Spine Outcomes Questionnaire; CNFDS: Copenhagen Neck Functional Disability Scale; NBQ: Neck Bournemouth Questionnaire; NDI: Neck Disability Index; NFSQ: Neck Functional Status Questionnaire; NOOS: Neck OutcOme Score; NPDS: Neck Pain and Disability Scale; NPFLS: Neck Pain and Functional Limitation Scale; NPNPQ: Northwick Park Neck Pain Questionnaire; PFM: ProFitMap-neck. Criterion questionnaires; MPQ: McGills Pain Questionnaire; ODI: Oswestry Disability Index; PDI: Pain Disability Index; SF-36: Short Form 36 Health Survey; SES: Self Efficacy Scale.

BenDebba M, Heller J, Ducker TB, et al. Cervical spine outcomes questionnaire: its development and psychometric properties. Spine. 2002;27:2116–2123.

 PubMed Web of Science ®Google Scholar

Jordan A, Manniche C, Mosdal C, et al. The Copenhagen Neck Functional Disability Scale: a study of reliability and validity. J Manipulat Physiol Ther. 1998;21:520–527.

 PubMed Web of Science ®Google Scholar

Bolton JE, Humphreys BK. The Bournemouth Questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. J Manipulat Physiol Ther. 2002;25:141–148.

 PubMed Web of Science ®Google Scholar

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulat Physiol Ther. 1991;14:409–415.

 PubMed Web of Science ®Google Scholar

Wheeler AH, Goolkasian P, Baird AC, et al. Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity. Spine. 1999;24:1290–1294.

 PubMed Web of Science ®Google Scholar

Leonard JH, Choo CP, Manaf MR, et al. Development and evaluation of ‘neck pain and functional limitation scale’: a validation study in the Asian context. Indian J Med Sci. 2009;63:445–454.

 PubMedGoogle Scholar

Wang YC, Cook KF, Deutscher D, et al. The Development and Psychometric Properties of the Patient Self-Report Neck Functional Status Questionnaire (NFSQ). J Orthop Sports Phys Ther. 2015;45:683–692.

 PubMed Web of Science ®Google Scholar

Juul T, Sogaard K, Roos EM, et al. Development of a patient-reported outcome: the Neck OutcOme Score (NOOS)–Content and construct validity. J Rehabil Med. 2015;47:844–853.

 PubMed Web of Science ®Google Scholar

Leak AM, Cooper J, Dyer S, et al. The Northwick Park Neck Pain Questionnaire, devised to measure neck pain and disability. Br J Rheumatol. 1994;33:469–474.

 PubMedGoogle Scholar

Bjorklund M, Hamberg J, Heiden M, et al. The ProFitMap-neck–reliability and validity of a questionnaire for measuring symptoms and functional limitations in neck pain. Disabil Rehabil. 2012;34:1096–1107.

 PubMed Web of Science ®Google Scholar

Skolasky RL, Riley LH, Albert TJ. Psychometric properties of the Cervical Spine Outcomes Questionnaire and its relationship to standard assessment tools used in spine research. Spine J. 2007;7:174–179.

 PubMed Web of Science ®Google Scholar

Skolasky RL, Albert TJ, Vaccaro AR, et al. Patient satisfaction in the cervical spine research society outcomes study: relationship to improved clinical outcome. Spine J. 2009;9:232–239.

 PubMed Web of Science ®Google Scholar

Pickering PM, Osmotherly PG, Attia JR, et al. An examination of outcome measures for pain and dysfunction in the cervical spine: a factor analysis. Spine. 2011;36:581–588.

 PubMed Web of Science ®Google Scholar

Gay RE, Madson TJ, Cieslak KR. Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain. J Manipulat Physiol Ther. 2007;30:259–262.

 PubMed Web of Science ®Google Scholar

Geri T, Piscitelli D, Meroni R, et al. Rasch analysis of the Neck Bournemouth Questionnaire to measure disability related to chronic neck pain. J Rehabil Med. 2015;47:836–843.

 PubMed Web of Science ®Google Scholar

Bolton JE. Sensitivity and specificity of outcome measures in patients with neck pain: detecting clinically significant improvement. Spine. 2004;29:2410–2417.

 PubMed Web of Science ®Google Scholar

Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulat Physiol Ther. 2004;27:26–35.

 PubMed Web of Science ®Google Scholar

McCarthy MJH, Grevitt MP, Silcocks P, et al. The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J. 2007;16:2111–2117.

 PubMed Web of Science ®Google Scholar

En MCC, Clair DA, Edmondston SJ. Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring disability associated with chronic, non-traumatic neck pain. Manual Ther. 2009;14:433–438.

 PubMed Web of Science ®Google Scholar

Hains F, Waalen J, Mior S. Psychometric properties of the neck disability index. J Manipulat Physiol Ther. 1998;21:75–80.

 PubMed Web of Science ®Google Scholar

Gabel CP, Cuesta-Vargas AI, Osborne JW, et al. Confirmatory factory analysis of the Neck Disability Index in a general problematic neck population indicates a one-factor model. Spine J. 2014;14:1410–1416.

 PubMed Web of Science ®Google Scholar

Riddle DL, Stratford PW. Use of generic versus region-specific functional status measures on patients with cervical spine disorders. Phys Ther. 1998;78:951–963.

 PubMed Web of Science ®Google Scholar

Juul T, Sogaard K, Davis AM, et al. Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form-36 were evaluated in patients with neck pain. J Clin Epidemiol. 2016;79:31–40.

 PubMed Web of Science ®Google Scholar

Goolkasian P, Wheeler AH, Gretz SS. The neck pain and disability scale: test–retest reliability and construct validity. Clin J Pain. 2002;18:245–250.

 PubMed Web of Science ®Google Scholar

Sim J, Jordan K, Lewis M, et al. Sensitivity to change and internal consistency of the Northwick Park Neck Pain Questionnaire and derivation of a minimal clinically important difference. Clin J Pain. 2006;22:820–826.

 PubMed Web of Science ®Google Scholar

Bjorklund M, Wiitavaara B, Heiden M. Responsiveness and minimal important change for the ProFitMap-neck questionnaire and the Neck Disability Index in women with neck-shoulder pain. Qual Life Res. 2016;26:161–170.

 PubMed Web of Science ®Google Scholar