This article summarizes a new questionnaire developed by Dr. Howard Vernon, DC, designed to assess whiplash patients. The survey is a modification of the Oswestry Low Back Disability Index. Each category contains 6 possible answers, scored from 0 to 5. Scores are totaled, and a rating is determined: 0-4 = No disability; 5-14 = Mild disability; 15-24 = Moderate disability; 25-34 = Severe Disability; 35-50 = Complete disability. The test has been studied a number of times and has been found to be a reliable and accurate assessment of neck pain disability. The following is a copy of the survey, as the article states that, "its duplication and use is encouraged."
This survey provides a simply tool for quantifying neck pain disability, and the author suggests using it to evaluate a patient's progress and to determine severity of disability. Please feel free to copy the following page and use this survey in your practice.
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This questionnaire has been designed to give the doctor information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the ONE box which applies to you. We realize you may consider that two of the statements in any one section relate to you, but just mark the one box which most clearly describes your problem.
Section 1 — Pain Intensity
- I have no pain at the moment.
- The pain is very mild at the moment.
- The pain is moderate at the moment.
- The pain is fairly severe at the moment.
- The pain is the worst imaginable at the moment.
Section 2 — Personal Care
- I can look after myself normally without causing extra pain.
- I can look after myself normally but it causes extra pain.
- It is painful to look after myself and I am slow and careful.
- I need some help but manage most of my personal care.
- I need help every day in most aspects of self care.
- I do not get dressed, I wash with difficulty and stay in bed.
Section 3 — Lifting
- I can lift heavy weights without extra pain.
- I can lift heavy weights but it gives me extra pain.
- Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, for example on a table.
- I can lift very light weights.
- I cannot lift or carry anything at all.
Section 4 — Reading
- I can read as much as I want to with no pain in my neck.
- I can read as much as I want to with slight pain in my neck.
- I can read as much as I want with moderate pain in my neck.
- I can't read as much as I want because of moderate pain in my neck.
- I can hardly read at all because of severe pain in my neck.
- I cannot read at all.
Section 5 — Headaches
- I have no headaches at all.
- I have slight headaches which come infrequently.
- I have moderate headaches which come infrequently.
- I have moderate headaches which come frequently.
- I have severe headaches which come frequently.
- I have headaches almost all the time.
Section 6 — Concentration
- I can concentrate fully when I want to with no difficulty.
- I can concentrate fully when I want to with slight difficulty.
- I have a fair degree of difficulty in concentrating when I want to.
- I have a lot of difficulty in concentrating when I want to.
- I have a great deal of difficulty in concentrating when I want to.
- I cannot concentrate at all.
Section 7 — Work
- I can do as much work as I want to.
- I can only do my usual work, but no more.
- I can do most of my usual work, but no more.
- I cannot do my usual work.
- I can hardly do any work at all.
- I can't do any work at all.
Section 8 — Driving
- I can drive my car without any neck pain.
- I can drive my car as long as I want with slight pain in my neck. I can drive my car as long as I want with moderate pain in my neck.
- I can't drive my car as long as I want because of moderate pain in my neck.
- I can hardly drive at all because of severe pain in my neck.
- I can't drive my car at all.
Section 9 — Sleeping
- I have no trouble sleeping.
- My sleep is slightly disturbed (less than 1 hour sleepless).
- My sleep is mildly disturbed (1-2 hours sleepless).
- My sleep is moderately disturbed (2-3 hours sleepless).
- My sleep is greatly disturbed (3-5 hours sleepless).
- My sleep is completely disturbed (5-7 hours sleepless).
Section 10 — Recreation
- I am able to engage in all my recreation activities with no neck pain at all.
- I am able to engage in all my recreation activities, with some pain in my neck.
- I am able to engage in most, but not all, of my usual recreation activities because of pain in my neck.
- I am able to engage in a few of my usual recreation activities because of pain in my neck.
- I can't do any recreation activities at all.
Vernon H. The neck disability index: patient assessment and outcome monitoring in whiplash. Journal of Musculoskeletal Pain 1996;4(4):95-104. (Reprints of this article are available from Haworth Medical Press, 1-800-342-9678.)