Neck Disability Index Form PDF Details

Understanding the impact of neck pain on an individual’s daily life is crucial for providing targeted and effective treatment. The Neck Disability Index (NDI) form serves as a powerful tool in this assessment, offering insights into how neck pain affects a wide range of activities including personal care, lifting, reading, concentration, work, driving, sleeping, headaches, and recreational activities. By marking statements that most closely describe their current situation, patients provide healthcare professionals with a detailed view of the pain's intensity and its interference with day-to-day functions. The NDI form categorizes responses across ten sections, each focusing on a specific aspect of living with neck pain, from the absence of pain and no disruption to activities, to the worst imaginable pain and complete inability to perform certain tasks. This comprehensive approach not only highlights the physical limitations caused by neck discomfort but also sheds light on how it can affect emotional well-being and mental focus. The NDI form, with its patient-centered approach, bridges the communication gap between patients and healthcare providers, allowing for a more individualized and effective management plan.

QuestionAnswer
Form NameNeck Disability Index Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesneck disability index, pain disability scale forms, neck disability index questionnaire spanish, neck

Form Preview Example

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.

SECTION 1 - PAIN INTENSITY

SECTION 6 – CONCENTRATION

I have no neck 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.

I can concentrate fully without difficulty.

I can concentrate fully with slight difficulty.

I have a fair degree of difficulty concentrating. I have a lot of difficulty concentrating.

I have a great deal of difficulty concentrating. I can't concentrate at all.

SECTION 2 - PERSONAL CARE

SECTION 7 – WORK

I can look after myself normally without causing extra neck pain.

I can look after myself normally, but it causes extra neck pain.

It is painful to look after 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 self -care.

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

SECTION 3 – LIFTING

I can lift heavy weights without causing extra neck pain. I can lift heavy weights, but it gives me extra neck pain. Neck pain prevents me from lifting heavy weights off the floor but I can manage if items are conveniently positioned, ie. on a table.

Neck pain prevents me from lifting heavy weights, but I can manage light weights if they are conveniently positioned

I can lift only very light weights.

I cannot lift or carry anything at all.

SECTION 4 – READING

I can read as much as I want with no neck pain.

I can read as much as I want with slight neck pain.

I can read as much as I want with moderate neck pain. I can't read as much as I want because of moderate neck pain.

I can't read as much as I want because of severe neck pain.

I can't read at all.

SECTION 5 – HEADACHES

I have no headaches at all.

I have slight headaches that come infrequently.

I have moderate headaches that come infrequently. I have moderate headaches that come frequently. I have severe headaches that come frequently.

I have headaches almost all the time.

I can do as much work as I want.

I can only do my usual work, but no more.

I can do most of my usual work, but no more.

I can't do my usual work.

I can hardly do any work at all.

I can't do any work at all.

SECTION 8 – DRIVING

I can drive my car without neck pain.

I can drive my car with only slight neck pain.

I can drive as long as I want with moderate neck pain. I can't drive as long as I want because of moderate neck pain.

I can hardly drive at all because of severe neck pain. I can't drive my care at all because of neck pain.

SECTION 9 – SLEEPING

I have no trouble sleeping.

My sleep is slightly disturbed for less than 1 hour. My sleep is mildly disturbed for up to 1-2 hours.

My sleep is moderately disturbed for up to 2-3 hours. My sleep is greatly disturbed for up to 3-5 hours. My sleep is completely disturbed for up to 5-7 hours.

SECTION 10 – RECREATION

I am able to engage in all my recreational activities with no neck pain at all.

I am able to engage in all my recreational activities with some neck pain.

I am able to engage in most, but not all of my recreational activities because of pain in my neck.

I am able to engage in a few of my recreational activities because of neck pain.

I can hardly do recreational activities due to neck pain. I can't do any recreational activities due to neck pain.

P ATI EN T N AM E _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

D ATE _ _ _ _ _ _ _ _ _ _ _ _ _

 

7

SCORE __________ [50]

COPYRIGHT: VERNON H & HAGINO C, 1991

 

HVERNON@CMCC.CA

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neck index disability form printable completion process detailed (portion 1)

2. Once your current task is complete, take the next step – fill out all of these fields - SECTION LIFTING cid I can lift, SECTION READING cid I can read, SECTION HEADACHES cid I have no, SECTION SLEEPING cid I have no, SECTION RECREATION cid I am able, PATI EN T N AM E, and D ATE with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling out part 2 in neck index disability form printable

3. Completing PATI EN T N AM E, COPYRIGHT VERNON H HAGINO C, and HVERNONCMCCCA is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Stage number 3 for filling out neck index disability form printable

Be really careful while completing PATI EN T N AM E and HVERNONCMCCCA, as this is the section where a lot of people make errors.

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