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					                                                                                                                  Performance


Evidence Table. Assessment: Self Assessment Questionnaires (NPTF)
Admissible articles that describe questionnaire selected performance variables are included in this table. Only significant values are listed and the following cut-
offs were used: inter class correlation r = > .70; kappa > .40; p < 0.05; Cronbach’s alpha > 0.8. * Only performances measured by the author(s) are displayed.




Author(s),                        Setting,                         Case Definition                                     Performance*
Year,                        Number (n) Enrolled,
(Number)                         Language                                                                                  Validity
                                                                                                                        -Construct / Gold Standard
Study Design,                                                                                                          -Content – Y / N
Questionnaire                                                                                                          -Predictive – Y / N

                                                                                                                          Reliability

                                                                                                                Responsiveness to change
Jordan, et al.;   Setting – University Hospital,   Case definition –                               Validity
1998              Department of Neurosurgery,      Three groups          Construct / Gold Standard – Correlation of disability scores
                  out patient clinic               Sample 1 –            with doctor and patient global assessments and physical
Reliabiltiy and                                    random sample         measures
validity studySubjects – 3 samples; 39             from a mail
              patients who had neck surgery        survey to all         Sample 1
Copenhagen    previously; 21 patients seeking      patients who had      Disability and pain r = .83 (p < .0001)
Neck          outpatient care for chronic neck     cervical disc
Functional    pain; 102 patients who had been      surgery from          Disability and patient’s global assessment r = .89 (p <
Disability    part of a randomized clinical        1990-1994 at a        .0001)
Scale (CNFDS) trial for treatment of chronic       specified hospital
              neck pain                            Sample 2 –            Sample 3
                                                   consecutive           Disability and pain r = .64 (p < .0001)
                  n= 162                           patients seeking
                                                   care at a specified   Content – Yes, good general agreement with the NDI
                  Language - English               clinics whose pain    (headache, lifting leisure time)
                                                   and disability
                                                   levels were                                    Reliability
                                                   unchanged             Short term test-retest
                                                   between first and     Sample 1 r = .99 (p = < .0001) and ICC 0.99
                                                   second visits         Sample 2 r = .96 (p = < .0001) and ICC 0.95
                                                   Sample 3 –
                                                   Participants in a     Cronbach’s alpha (entire scale) 0.897
                                                   RCT for the
                                                   treatment of                            Responsiveness to change
                                                   chronic               Very responsive to change in short and long term patient
                                                   mechanical neck       status
                                                   pain at a specified   Correlations of changes in disability scores to changes in
                                                   hospital              pain scores:
                                                                         at the conclusion of treatment r = .49; p < .0001);
                                                                         at 4 month follow up r = .48 (p < .0001);
                                                                         at 12 month follow up r = .54 (p < .0001)
Hains, et al.,    Setting – Chiropractic college    Case definition - >                             Validity
1998              outpatient clinic and private     17 years old with     Construct / Gold Standard – Pain Intensity Visual Analog
                  chiropractic clinics, Canada      neck pain (acute,     Scale – Question 1 (neck pain intensity) on the NDI and the
Cross-sectional                                     subacute and          total NDI score were jointly predictive of Pain Intensity
study             Subjects – Those with neck pain   chronic)              VAS
                  seeking chiropractic treatment
Neck Disability                                                                                    Reliability
Index (NDI)     n= 237                                                    Cronbach’s alpha 0.92

                  Language - English                                                       Responsiveness to change
                                                                          Not measured


                                                                          No evidence of response set or item order bias – that is, the
                                                                          order of the items or the order of the response categories did
                                                                          not influence the total score or scores on individual items
BenDebba et       Setting – Hospital Neurosurgery     Case definition –                                Validity
al., 2002         and Orthopedic Clinics              convenience          Construct / Gold Standard – Oswestry Disability Index
                                                      sample of possible   (ODI) and SF-36 - Although some correlations were shown
Cross sectional   Subjects – convenience sample       anterior fusion      all values fell below 0.70 However some interesting clinical
study             of possible surgical out-patients   surgical patients    patterns of correlations [<0.70] generally supported
                  with neck pain                      with neck pain       construct validity. For instance, CSOQ pain correlated most
Cervical Spine                                                             highly with SF36 pain (r=-0.50 and -0.57), CSOQ physical
Outcomes          n= 216                                                   symptoms correlated most highly with SF-36 physical
Questionnaire                                                              function (r=-0.50), and CSOQ psychological distress
(CSOQ)            Language - English                                       correlated most highly with SF36 mental health (r=-0.61),
                                                                           vitality (r=-0.59) and aggregate mental component score
                                                                           (r=-.065).

                                                                                                     Reliability
                                                                           Test-Retest ICC for each of the six composite measures
                                                                           correlating 3 month and 6 month scores: neck pain severity
                                                                           (0.80); shoulder arm pain severity (0.80), functional
                                                                           disability (0.85), psychological distress (0.82), physical
                                                                           symptoms other than pain (0.86), health care utilization
                                                                           (0.75)

                                                                                            Responsiveness to change
                                                                           Large and significant differences between improved and
                                                                           unimproved in all composite scores except health care
                                                                           utilization
Williams et al.   Setting – Outpatient clinic      Group 1 (n=10)                                Validity
2001                                               Patients          Construct / Gold standard – SF-12 (physical and mental) –
                  Subjects - patients attending an                   an inverse correlation (all values are negative) was expected
3 groups -        outpatient musculoskeletal clinic Group 2 (n=15)   and shown because SF-12 scores increase with improved
n=10, 15, and                                       Researcher’s     health while Aberdeen Pain Scales decrease with improved
512               n= 249                            colleagues       health.
                                                                     Neck APS and SF-12
Aberdeen          Language - English               Group 3 (n=512)   Physical -0.62; Mental -0.44
Spine Pain                                         Consecutive
Scale (APS)                                        patients with     Upper back APS and SF-12
                                                   neck, upper or    Physical –0.67; Mental – 0.33
                                                   lower back pain
                                                                     Lower back APS and SF-12
                                                                     Physical – 0.58; Mental – 0.33

                                                                     Content –
                                                                     Questions were correlated with the total score omitting that
                                                                     question (correlations > 0.2 remained in the questionnaire).
                                                                     Three versions of the questionnaire:
                                                                     Neck (21 questions) – correlations for 19 questions ranged
                                                                     between 0.21-0.66)
                                                                     Upper back (25 questions) - correlations for 24 questions
                                                                     ranged between 0.24-0.70)
                                                                     Lower back (34 questions) - correlations for 33 questions
                                                                     ranged between 0.23-0.64)


                                                                                             Reliability –
                                                                     Reported as mean change in scores test-re-test with (95%
                                                                     CI) for patients who reported no change on global health
                                                                     assessment

                                                                     Pre-treatment:
                                                                     Neck 4.7 (2.6-6.8)
                                                                     Upper back 2.5 (0.2-4.9)
                                                                     Lower back 3.5 (1.5-5.4)
Hoving et al.,    Setting – Hospital research unit   Case definition –                             Validity
2003                                                 WAD with no         Construct / Gold standard – Problem Elicitation Technique
                  Subjects – Patients with varying   history of neck     (PET)
Cross sectional   degrees of WAD who attend          pain prior to the   NDI and PET r = 0.57 p < 0.01;
study             physical therapy                   MVA, inability to   NPQ and PET r = 0.56 p < 0.01
                                                     read English or
Neck Disability n= 71                                concussion at the   Correlation of NDI and NPQ r=0.88 p < 0.01
Index (NDI),                                         time of the
Northwick       Language - English                   accident            Content – NDI and NPQ did not measure emotional and
Park Neck Pain                                                           social function, which is measured by PET
Questionnaire
(NPQ),
Problem
Elicitation
Technique
(PET)
Chiu et al.       Setting – Seven outpatient         Case definition –                              Validity
2001              physical therapy departments       patients with neck   Construct / Gold standard - Current Perceived Health 42
                                                     pain seeking         (CPH42) and the Verbal Numerical Pain Scale (VNPS);
Prospective       Subjects – Consecutive patients    outpatient           Cross sectional construct validity r= 0.58-0.59;
cross sectional   with neck pain attending           physical therapy     Longitudinal construct validity r= 0.50-0.51
study             physical therapy                   treatment
                                                                          Content – as evaluated by ten physiotherapists and ten neck
Northwick         n=594 (not all subjects used for                        pain patients was considered good to very good
Park Neck Pain    each analysis)
Questionnaire                                                                                     Reliability
(NPQ)             Language – Chinese                                      Test-Retest ICC 0.95 (95% CI 0.93-0.96);
                                                                          Cronbach’s alpha = 0.83-0.87

                                                                                           Responsiveness to change
                                                                          Change in questionnaire scores from baseline to six weeks
                                                                          (expressed as Effect Sizes):
                                                                          Northwick Park Pain Questionnaire 1.11;
                                                                          CPH42 0.79;
                                                                          VNPS 1.03
                                                                          In those who reported improvement:
                                                                          Northwick Park Pain Questionnaire 1.36;
                                                                          CPH42 0.92;
                                                                          VNPS 1.23
Gonzalez, et      Setting – not defined           Case definition –                               Validity
al., 2001                                         Patients with neck   Construct / gold standard - Correlation between Neck Pain
                  Subjects – Outpatients with     pain longer than 4   VAS and NPQ:
Cross sectional   chronic non-inflammatory neck   months, without      Baseline r = 0.51 p = 0.0001;
study             pain (more than 4 months        history of neck      Retest (one week after baseline) r = 0.74 p = 0.0001;
                  duration)                       surgery,             After treatment r = 0.60 p = 0.0001
Northwick                                         neurological
Park Neck Pain    n= 58                           deficits,
Questionnaire                                     malignancies or
(NPQ)             Language - Spanish              inflammatory                                  Reliability
                                                  arthritis            Test-Retest ICC =0.63 (range of ICC for each of the 9
                                                                       sections of the questionnaire) = 0.42 – 0.85
                                                                       Internal Consistency – Author reports some discrepancy
                                                                       between certain variables (numbness, carrying, work) and
                                                                       pain intensity, however full analysis not reported


                                                                                         Responsiveness to change
                                                                       Comparing pre-treatment to 3 months post-PT-treatment:
                                                                       All sections except driving show significant improvement
                                                                       over time via t-test
Bicer et al.,     Setting – Hospital outpatient   Case definition –                                Validity
2004              Physical Medicine and           Outpatients with      Construct / gold standard – Correlation with Pain VAS
                  Rehabilitation Department       neck pain > 6         (0.45), Pain Disability Index (0.51) and Hospital Anxiety
Cross sectional                                   months who            and Depression Scale (depression scale 0.35, anxiety scale
study             Subjects – Chronic neck pain    applied or referred   0.33)
                  (more than 6 months)            to the PMR
Neck Pain and                                     department,                                   Reliability
Disability        n= 61                           without               Cronbach’s alpha = 0.86 (p < 0.0001)
Scale (NPDS)                                      comorbidities,
                  Language - Turkish              neck surgery
                                                  within the
                                                  previous 3
                                                  months, or
                                                  pregnant


Pinfold et al.    Setting – Outpatient physical   Case definition –                               Validity
2004              therapy private practices       patients receiving    Construct / gold standard – no information provided
                                                  outpatient
Cross sectional   Subjects – patients with WAD    physical therapy      Content – no apparent floor or ceiling effects noted
study                                             treatment for
                  n= 101                          whiplash injuries,                              Reliability
Whiplash                                          at least 18 years     Cronbach’s alpha = 0.96
Disability        Language - English              old
Questionnaire
(WDQ)
Wlodyka-           Setting – Hospital in- and out-   Case definition –                              Validity
Demaille et al.,   patient and PT departments        18 – 70 year old     Construct / gold standard – Patient’s opinion – improved,
2004                                                 adults able to       remained stable, deteriorated. For all scales best correlation
                   Subjects – patients with non-     speak/read French    with patient opinion of neck disorder NPDS (r = 0.59); for
Observational      inflammatory neck pain > 15       with neck pain or    opinion of patient perceived handicap NPDS (r = 0.58)
prospective        days seeking outpatient           cervical neuralgia
study              treatment                         >15 days, without
                                                     arthritis or                         Responsiveness to change
Neck Disability n= 71                                inflammatory         Expressed as Effect Size (ES) and Standardized Response
Index (NDI),                                         disease,             Mean (SRM)
Neck Pain and Language – French                      tumor/metastasis,
Disability                                           myopathy, severe     Significant differences noted for patients who improved on
Scale (NPDS),                                        psychiatric          all measures:
Northwick                                            disorder             NDI ES 0.55; SRM 0.55
Park Neck Pain                                                            NPDS ES 0.46; SRM 0.38
Questionnaire                                                             NPQ ES 0.70; SRM 0.81
(NPQ), Visual                                                             VAS P ES 0.82; SRM 0.56
Analog Scale -                                                            VAS H ES 0.74; SRM 0.68
Pain (VAS P)
and Handicap                                                              Significant differences noted for patients who deteriorated
(VAS H)                                                                   on NDI, NPDS and NPQ:
                                                                          NDI      ES -0.67; SRM -0.77
                                                                          NPDS ES -1.06; SRM -1.14
                                                                          NPQ      ES -0.56; SRM -0.64
                                                                          VAS P ES -0.31; SRM -0.32
                                                                          VAS H ES 0.08; SRM 0.10
                                                                          No significant difference for patients who remained stable
                                                                          on any of the measures
                                                                          NDI      ES -0.25; SRM -0.34
                                                                          NPDS ES -0.25 ; SRM -0.26
                                                                          NPQ      ES -0.06; SRM -0.08
                                                                          VAS P ES 0.12; SRM 0.13
                                                                          VAS H ES 0.22; SRM 0.30


                                                                          NPDS scores significantly different between patients who
                                                                          deteriorated and who improved (P = 0.0001) and between
Riddle et al.,  Setting – 4 PT out-patient clinics Case definition –                                  Validity
1998                                               Patients referred     Construct / gold standard – Active range of motion, work
                Subjects – patients with cervical for PT due to          status, litigation status, and the two scales were compared to
Cross sectional spine pain referred for outpatient problems in the       each other
study           PT                                 cervical spine
                                                   only; patients with   Weak correlations (ranging from 0.12 to 0.36) between
Neck Disability n= 146                             other conditions      AROM and both the SF-36 and NDI.
Index (NDI)                                        or problems that
and SF-36       Language - English                 may effect            Patients working had significantly higher scores on SF-36
[PCS (physical                                     functional status     MCS, SF-36 PCS and NDI as compared to patients not
component                                          were excluded         working as per a priori hypotheses.
summary) and
MCS (mental                                                              Patients not involved in litigation had significantly higher
component                                                                scores on SF-36 MCS and NDI (as per a priori hypotheses),
summary]                                                                 but not on SF-36 PCS

                                                                         Correlation between NDI and SF-36 (MCS 0.47 and PCS
                                                                         0.53) and correlation between SF-36 MCS and SF-36 PCS
                                                                         was low at 0.08 as hypothesized

                                                                                           Responsiveness to change
                                                                         Both scales were responsive to change over time. The NDI
                                                                         and SF-36 PCS were able to differentiated between levels of
                                                                         goals attained (met versus not met) and change in work
                                                                         status; NDI and SF-36 MCS were able to differentiate
                                                                         between levels of litigation. Considerable overlap suggests
                                                                         use of only one of these scales would be sufficient for
                                                                         patients with cervical spine problems
Chiu et al.,    Setting – seven PT outpatient      Case definition -                              Validity
2005            departments                        >18 years old,       Construct / gold standard – Numerical rating scale (NRS);
                                                   consecutive adult    rank correlation between the CPH and the NRS done at
Prospective     Subjects – Chinese consecutive     patients with neck   entry to study and at 6 weeks (0.41 and 0.49)
observational   patients with neck pain referred   pain referred to
study           for outpatient PT                  PT by a medical                                Reliability
                                                   practitioner,        Test–Retest reliability ICC 0.91;
Current         n= 472                             without metastasis   Cronbach’s alpha 0.90
Perceived                                          or infection,
Health 42       Language - Chinese                 concurrent MS                         Responsiveness to change
(CPH42)                                            problems, pending    CPH 42 comparison between beginning of treatment and
                                                   litigation,          week 3 Standardized Response Mean (SRM) = 0.33 and at
                                                   compensatory         week 6 SRM = 0.36; NRS comparison between beginning
                                                   claims               of treatment and week 3 SRM = 0.38 and at week 6 SRM =
                                                                        0.50
Kaale et al.      Setting - Primary care, Western    Case definition –                                    Validity
2005              Norway                             92 WAD 2 patient                                  Not measured
                                                     12-16 weeks after                                  Reliability
                  Subjects – Controls: A random      a motor vehicle                                   Not measured
                  sample of 30 subjects drawn        accident                                    Responsiveness to change
                  from a list of 300, treated by                              NDI – Control group 20.3 SD 15.6) and WAD 2 42.6 (SD
                  physical therapists for problems                            18.0)
                  unrelated to neck pain                                      NDI – significant changes in NDI scores noted with MRI
                  WAD 2: A random sample                                      abnormalities of the alar ligament (mean difference between
                  drawn from a list of 297 from                               control and WAD 12.0 (95% CI 4.4-19.6); WAD patients
                  seven communities                                           with several abnormal (grade 2-3) lesions had higher
                                                                              disability scores than those with few or no abnormal
                  n= 122                                                      structures with some gender variation noted

                  Language - Norwegian

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