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Cervical Disability Assessment Questionnaire

Neck Disability Index (NDI)

Your tracking information

Last Name *

First name *

Phone *

Email *

Symptoms and Physical Condition

Pain intensity *

Not applicable
0 I'm not feeling any pain right now
1 The pain is very mild right now
2 The pain is moderate right now
3 The pain is pretty severe right now
4 The pain is very severe right now
5 The pain is unbearable right now

Sleep *

Not applicable
0 The pain doesn't keep me awake
1 The pain occasionally interferes with my sleep
2 Because of the pain, I sleep less than 6 hours
3 Because of the pain, I sleep less than 4 hours
4 Because of the pain, I sleep less than 2 hours
5 The pain keeps me from sleeping at all

Headaches *

Not applicable
0 I don't have a headache
1 I have mild headaches, which occur rarely
2 I have mild headaches, which occur rarely
3 I have moderate headaches that occur frequently
4 I have severe headaches that occur frequently
5 I have headaches almost all the time

Concentration *

Not applicable
0 I can concentrate fully without any difficulty
1 I can concentrate fully with only slight difficulty
2 I have a real hard time concentrating
3 I have a lot of trouble concentrating
4 I have a very hard time concentrating
5 I can't concentrate

Independence and Personal Care

Bathing and dressing *

Not applicable
0 I dress myself/take care of myself on my own, pain remains the same
1 I can wash and dress myself, but it’s painful
2 These activities cause pain, so I'm being careful and taking it slow
3 I need help, but I handle the basics on my own
4 I need help every day with most activities
5 I don't get dressed, have trouble washing myself, and stay in bed

Lifting objects *

Not applicable
0 I can lift heavy objects without causing pain
1 I can lift heavy objects, but it causes pain
2 The pain prevents me from lifting heavy objects unless they are properly positioned (e.g., on a table)
3 The pain prevents me from lifting heavy objects, but I can lift light to moderately light objects if they are positioned correctly
4 I can only lift very light objects
5 I can't lift or carry anything

Reading *

Not applicable
0 I can read as much as I want without getting a stiff neck
1 I can read as much as I want, but it causes me a little pain
2 I can read as much as I want, but it causes me some discomfort
3 I can't read as much as I'd like because of some mild pain
4 I have a hard time reading because of severe pain
5 I can't read at all

Active Living and Mobility

Work *

Not applicable
0 I can work as much as I want
1 I can only do my usual work, nothing more
2 I can only do most of my usual work
3 I can't do my usual work
4 I find it hard to work
5 I can't work

Driving *

Not applicable
0 I can drive my car without neck pain
1 I can drive my car, but it causes me some pain
2 I can drive my car, but it causes me moderate pain
3 I can't drive my car as much as I'd like because of neck pain
4 I have a hard time driving my car because of neck pain
5 I can't drive at all

Leisure *

Not applicable
0 I can enjoy all my hobbies without neck pain
1 I can do all my hobbies, but with some pain
2 I can still enjoy most of my hobbies despite the pain
3 I can only do a few leisure activities because of the pain
4 I find it difficult to enjoy my hobbies because of the pain
5 I can no longer enjoy my hobbies

Your disability score (NDI)

This score reflects the current impact of your pain on your daily activities.

%

Pain felt

How much neck pain are you currently experiencing? *

(0 = no pain, 10 = unbearable pain)

How much pain are you currently experiencing in your arm? *

(0 = no pain, 10 = unbearable pain)

I consent to these data being shared with my healthcare provider.

The data collected is processed in accordance with our privacy policy.

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Spécialiste FMH en Chirurgie orthopédique | Chirurgie spinale endoscopique

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