AN EXAMINATION OF OUTCOME MEASURES FOR PAIN AND DYSFUNCTION IN THE CERVICAL SPINE PICKERING P, OSMOTHERLY P, ATTIA J, MCELDUFF P. SPINE 36(7):581-588 PRESENTED BY: TONY CUMMINGS, ALLY O BRYAN, STEPH SMITH, BRITTANY SMITHSON OUTCOME MEASURES Uses: Shows Progress to PT and Patient Objective Data on Functional Impairments Help Identify Limitations and Set Goals Components of Outcome Measures Content- type, scale, interpretation Clinician based vs. Patient based Clinician based are measured by the PT and considered objective Patient based are based on patient perceptions and considered subjective Psychometric Properties- validity, responsiveness, reliability Clinical Utility- patient and clinician friendly 1
BACKGROUND Current Outcome Measures for Neck Pain Neck Disability Index (NDI) Northwick Park Neck Pain Questionnaire (NPQ) Copenhagen Neck Functional Disability Scale (CNFDS) Neck Pain and Disability Scale (NPDS) High incidence in neck pain dysfunction but outcome measures are underdeveloped No reason for picking specific outcome measures for different neck pain dysfunctions Currently, no studies to compare these outcome measures with the same patient population NECK DISABILITY INDEX 10 Self-Reported Items 0-5 Likert Scale Questions Good internal consistency, reliability, construct validity Higher score = greater level of perceived disability 6 studies looked at factorial structure Derived from Oswestry Disability Index 2
OSWESTRY DISABILITY INDEX Gold standard outcome measure for low back pain 10 item questionnaire Patient reported outcome measure NDI was developed from Oswestry OSWESTRY DISABILITY INDEX VS NDI Oswestry Pain Personal care Lifting Walking Sitting Standing Sleeping Sex life Social life Traveling Neck Disability Index Pain Personal care Lifting Working Headaches Concentration Sleeping Driving Reading Recreation 3
NDI NORTHWICK PARK NECK PAIN QUESTIONNAIRE 8 Self-Reported Items 0-4 Likert Scale Questions Reliable, valid, and sensitive to change Higher scores = greater level of perceived disability 1 study looked at factorial structure 4
NPQ 5
COPENHAGEN NECK FUNCTIONAL DISABILITY SCALE 15 Self-Reported Items 0-2 Likert Scale Questions Partially derived from NDI and Low Back Pain Rating Scale High levels of reliability and internal consistency Higher scores = greater level of perceived disability Factorial structure has not been examined CNFDS 6
NECK PAIN AND DISABILITY SCALE 20 Self-Reported Items Reported with Visual Analog Scale: 0-5 Valid and reliable, sensitive to clinically relevant change, and responsive to multidimensional pain High scores = greater perceived pain and disability 6 studies examined factorial structure PURPOSE To examine and compare the factorial structure of the NDI, NPQ, CNFDS, and NPDS, and qualify their uses to assess specific aspects of neck disability. 7
MATERIALS AND METHODS Participants 88 participants with mechanical neck pain Inclusion criteria: mechanical neck pain, >18 years old, able to read and write English competently, willingness to participate Procedure Approved by Hunter Area Research Ethics Committee NDI, NPQ, CNFDS, NPDS were filled out in the same order by every patient in approximately 30 minutes MATERIALS AND METHODS (CONT.) Factor Analysis Item analysis was performed to determine item distribution and correlation. Exploratory Principle Components Factor Analysis (EFA) identified underlying factors. The Promax Oblique Rotation showed multiple dimensions. Each factor > 0.4 were considered significant for inclusion. 8
RESULTS- NDI RESULTS- NPQ 9
RESULTS- CNFDS RESULTS- NPDS 10
DISCUSSION NDI Neck pain and dysfunction related to general activities NPQ Dysfunction related to general activities Neck pain CNFDS Participation restriction influences psychosocial function Dysfunction related to general activities Cognitive function NPDS Dysfunction related to general activities and impact of participation restriction on psychosocial function Neck pain and interference with neck specific function Cognitive and emotional functioning LIMITATIONS Subjectivity of interpreting and characterizing factors No randomization of questionnaire administration Findings can only be applied to patients with mechanical neck pain 11
CLINICAL RELEVANCE Different factors need to be taken into consideration when selecting outcome measures for patients with mechanical cervical pain. Take a thorough subjective history first, then administer outcome measure. NPDS would be most useful for patients with multidimensional neck pain addressing dysfunction and pain, psychosocial, cognitive and emotional factors CLINICAL RELEVANCE TO CLASSIFICATIONS Cervical Hypomobility Outcome measure: NDI, NPQ, NPDS, CNFDS Varies depending on how patients present CPR to identify candidates for cervical HVT NDI <23% Cervical Radiculopathy Outcome measures: NDI, NPQ, NPDS, CNFDS Varies depending on how patients present Cervical Instability Outcome measure: NDI, NPQ Relates more to dysfunction Acute Pain/ Whiplash Outcome measure: NPDS, CNFDS Traumatic event leading to psychosocial issues Cervicogenic Headache Outcome measures: NPDS, CNFDS Deals with headaches, concentration, & focus 12
REFERENCES Centre for Evidence Based Physiotherapy. https://www.cebp.nl/. Accessed November 20, 2011. Olson, Kenneth. Examination and Treatment of Cervical Spine Disorders. Manual Physical Therapy of the Spine. St. Louis, MS: Sauders; 2009: 247-307. 13