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Measuring Neck Pain After Whiplash

Disability caused by neck pain can be measured using the Neck Disability Index (NDI). In this study, the NDI is translated into the Catalan language and tested with whiplash patients. The goal was to understand how chronic neck pain from a whiplash-associated disorder (WAD) can affect a patient's life. Secondary goals were to assist in planning treatment and measuring progress over time.

The NDI has been translated into many other languages. It is used primarily to assess disability in patients with neck pain. It has not necessarily been used with patients who have neck pain from a chronic whiplash disorder. The Catalan language is spoken by about nine million people around the world. It is most common in Spain, France, Italy, and Andorra.

A group of 150 whiplash patients from 10 rehab centers in Tarragona were included in this study. Tarragona is a city in the south of Catalonia (Spanish province) by the Mediterranean Sea. Each patient filled out the NDI and the Spanish version of the Beck Depression Inventory (BDI).

The NDI has 10 items that help describe how neck pain affects daily life. These include pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation.

Most of the patients were the drivers who experienced a whiplash injury. Almost three-fourths were women. The direction of the collision was from behind in more than half the cases. Side and front collisions accounted for one-third of the accidents.

Results from the data collected showed that the NDI had a two-factor structure. One subscale contains items that show how pain interferes with a person's cognitive function. Items that measure concentration and reading are in this category. The second subscale was labeled functional disability. These items measure how much neck pain affects physical activities such as work or lifting.

The authors suggest that the Catalan version of the NDI can be used to measure disability caused by neck pain from a whiplash injury. The two specific scores (subscales) help define areas of concern. With this information, treatment can be directed toward specific disabilities right from the start.

There are some things missing from the NDI for whiplash patients. For example, the effect of whiplash-related pain on sleep, emotions, and coping is not measured by the NDI. It may be necessary to find another way to measure these variables. Future studies are needed to focus on these targeted areas.


Rubén Nieto, BS, et al. Disability in Subacute Whiplash Patients. In Spine. August 15, 2008. Vol. 33. No. 18. Pp. E630-E635.

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