Developing a New Measurement Tool for Neck Pain

A study in the Journal of Rehabilitation Medicine marks an important primary step in establishing a valid, patient-reported neck pain scale that could ultimately help in diagnosis and treatment of the condition. The new tool, dubbed “NOOS” for Neck OutcOme Score, needs further development but could be an alternative to the neck disability index (NDI) for a pain condition that affects up to 14% of the US population.

Neck pain is insidious; it can be related to neuromuscular deficits, deficits in eye movement control, and impaired performance of muscles in the cervical spine. Thus, it often causes reduced work ability and significantly increases the risk of missed work days and other physical limitations. The NDI was originally developed to measure disability in activities of daily living, but it has some weaknesses that decrease its utility, including a lack of patient input and a lack of standardized procedures.

The researchers sought a patient-reported outcome (PRO) instrument that evaluates the impact of neck pain related to impairment, activity and participation. The NOOS tool is based, in part, on the well-established International Classification of Functioning, Disability and Health (ICF) bio-psycho-social framework. The ICF includes three domains: body functions and structure, activity, and participation. The authors then used learnings from clinical studies and focus groups that included patients, pain management specialists, and other healthcare professionals to develop the tool.

After the tool was developed, a total of 196 patients with neck pain (mean age 47.8 (SD 13.7) years), range 18—89 years; 146 women) completed the preliminary questionnaire. Overall, 35 items were removed from the original 69 questionnaire items. A multidimensional questionnaire, divided into five subscales, was developed from the remaining 34 items: mobility; symptoms; sleep disturbance; everyday activity and pain; and participation in everyday life. Exploratory factor analysis supported a 5-subscale structure.

“During the qualitative development process, patients with neck pain uncovered issues related to their neck problems, revealing complications such as movement difficulties, headache and dizziness, but more unforeseen issues related to participating in leisure activities and experiencing limitations in one’s life were also revealed,” the study authors noted. “Hence, the NOOS covers a broad spectrum of important aspects of life.”

While it mirrors the three domains of the ICF, the NOOS seeks to classify and categorize personal factors in a way that could successfully evaluate treatment regimens for neck pain as well. The authors hope that further research will test the reliability, construct validity, responsiveness and interpretability of the tool.