Validation of the recently developed Total Disability Index: a single measure of disability in neck and back pain patients

Restricted access

OBJECTIVE

Neck and back pain are highly prevalent conditions that account for major disability. The Neck Disability Index (NDI) and Oswestry Disability Index (ODI) are the two most common functional status measures for neck and back pain. However, no single instrument exists to evaluate patients with concurrent neck and back pain. The recently developed Total Disability Index (TDI) combines overlapping elements from the ODI and NDI with the unique items from each. This study aimed to prospectively validate the TDI in patients with spinal deformity, back pain, and/or neck pain.

METHODS

This study is a retrospective review of prospectively collected data from a single center. The 14-item TDI, derived from ODI and NDI domains, was administered to consecutive patients presenting to a spine practice. Patients were assessed using the ODI, NDI, and EQ-5D. Validation of internal consistency, test-retest reproducibility, and validity of reconstructed NDI and ODI scores derived from TDI were assessed.

RESULTS

A total of 252 patients (mean age 55 years, 56% female) completed initial assessments (back pain, n = 115; neck pain, n = 52; back and neck pain, n = 55; spinal deformity, n = 55; and no pain/deformity, n = 29). Of these patients, 155 completed retests within 14 days. Patients represented a wide range of disability (mean ODI score: 36.3 ± 21.6; NDI score: 30.8 ± 21.8; and TDI score: 34.1 ± 20.0). TDI demonstrated excellent internal consistency (Cronbach’s alpha = 0.922) and test-retest reliability (intraclass correlation coefficient = 0.96). Differences between actual and reconstructed scores were not clinically significant. Subanalyses demonstrated TDI’s ability to quantify the degree of disability due to back or neck pain in patients complaining of pain in both regions.

CONCLUSIONS

The TDI is a valid and reliable disability measure in patients with back and/or neck pain and can capture each spine region’s contribution to total disability. The TDI could be a valuable method for total spine assessment in a clinical setting, and its completion is less time consuming than that for both the ODI and NDI.

ABBREVIATIONS CAT = Computer Adaptive Test; ICC = intraclass correlation coefficient; MCID = minimum clinically important difference; NDI = Neck Disability Index; ODI = Oswestry Disability Index; PROMIS = Patient-Reported Outcomes Measurement Information System; rNDI = reconstructed NDI; rODI = reconstructed ODI; TDI = Total Disability Index; VAS = visual analog scale.
Article Information

Contributor Notes

Correspondence Themistocles S. Protopsaltis: NYU Langone Orthopaedic Hospital, New York, NY. themistocles.protopsaltis@nyulangone.org.INCLUDE WHEN CITING Published online December 6, 2019; DOI: 10.3171/2019.9.SPINE19331.Disclosures Dr. Hart: consulting and personal fees from DePuy, Globus Medical, Medtronic, and Orthofix Inc.; royalties from DePuy, Globus Medical, and SeaSpine; board or committee member of American Orthopaedic Association, Cervical Spine Research Society, North American Spine Society, International Spine Study Group, Scoliosis Research Society, and Western Orthopaedic Association; editorial or governing board of ISSLS textbook The Lumbar Spine; and research support from DePuy and Misonix. Dr. Ames: consultant for DePuy, K2M, Medicrea, Medtronic, Stryker, and Zimmer Biomet; royalties from Zimmer Biomet Spine, DePuy, Next Orthosurgical, NuVasive, Stryker, K2M, and Medicrea; research support from Titan Spine, DePuy Synthes, and ISSG; editorial board of Operative Neurosurgery; grant funding from SRS; executive committee of ISSG; and director of Global Spine Analytics. Dr. Burton: consultant for Bioventus and DePuy; patent holder with and royalties from DePuy and Zimmer Biomet; board or committee member of Scoliosis Research Society; editorial or governing board of Spine Deformity; research support for study described from DePuy; and support of non–study-related research from Pfizer. Dr. Smith: consultant for AlloSource, Cerapedics, K2M, NuVasive, and Zimmer Biomet; royalties from Zimmer Biomet; stock ownership in Alphatec; board or committee member of Cervical Spine Research Society; editorial or governing board of Neurosurgery and Operative Neurosurgery; research support for this study from DePuy Synthes/ISSG; and non–study-related support from AOSpine, DePuy Synthes/ISSG, and NREF. Dr. Shaffrey: consultant for Biomet Spine, Medtronic, NuVasive, Stryker, Siemens, and EOS; patent holder with and royalties from Zimmer Biomet, Medtronic, and NuVasive; direct stock ownership in NuVasive; research support from DePuy, Globus Medical, Medtronic, and NuVasive; board or committee member of Cervical Spine Research Society, AANS, and Neurosurgery RRC; and editorial or governing board for Spine Deformity and Spine. Dr. Schwab: consultant for K2M, Medicrea, Medtronic, NuVasive, Zimmer Biomet, Globus, and MSD; royalties from K2M, Medtronic, and Zimmer Biomet; direct stock ownership in Nemaris; research support from DePuy, NuVasive, and Stryker; board or committee member of Scoliosis Research Society and International Spine Study Group; editorial or governing board of Spine Deformity; speaking/teaching arrangements with Zimmer, Globus, K2M, and MSD; and non–study-related support from DePuy, NuVasive, Globus, Allosource, Orthofix, and SIBone. Dr. Errico: consultant for K2M; royalties from K2M and Fastenetix; research support from K2M; paid presenter/speaker for K2M; and board or committee member of Harms Study Group. Dr. Bess: consultant for AlloSource, DePuy, EOS, K2M, and Misonix; patent holder and royalties from K2M and Pioneer Spine; research support from AlloSource, Biomet Spine, DePuy, EOS, K2M, Medtronic, NuVasive, Orthofix, Inc., and ISSGF; and board or committee member of North American Spine Society and Scoliosis Research Society. Dr. Lafage: consultant for Globus Medical, DePuy, and K2M; direct stock ownership in Nemaris; research support from DePuy, Medtronic, NuVasive, and Stryker; board or committee member of the International Spine Study Group and Scoliosis Research Society; non–study-related support from DePuy Spine, Stryker, and NuVasive (grants paid through ISSGF); and speaking teaching arrangements with DePuy Spine and K2M. Dr. Protopsaltis: consulting and personal fees from Globus Medical, Innovasis, K2M, Medicrea, and NuVasive; and royalties from Altus Spine.
Headings
References
  • 1

    Bland JMAltman DG: Cronbach’s alpha. BMJ 314:5721997

  • 2

    Bogen K: The effect of questionnaire length on response rates: a review of the literature in Proceedings of the Section on Survey Research Methods. Washington, DC: American Statistical Association1996 pp 10201025

    • Search Google Scholar
    • Export Citation
  • 3

    Boody BSBhatt SMazmudar ASHsu WKRothrock NEPatel AA: Validation of Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests in cervical spine surgery. J Neurosurg Spine 28:2682792018

    • Search Google Scholar
    • Export Citation
  • 4

    Carnes DParsons SAshby DBreen AFoster NEPincus T: Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study. Rheumatology (Oxford) 46:116811702007

    • Search Google Scholar
    • Export Citation
  • 5

    Deyo RABattie MBeurskens AJBombardier CCroft PKoes B: Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23:200320131998

    • Search Google Scholar
    • Export Citation
  • 6

    Fairbank JCPynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:294029522000

  • 7

    Galesic MBosnjak M: Effects of questionnaire length on participation and indicators of response quality in a web survey. Public Opin Q 73:3493602009

    • Search Google Scholar
    • Export Citation
  • 8

    Hart LGDeyo RACherkin DC: Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 20:11191995

    • Search Google Scholar
    • Export Citation
  • 9

    Helgeson JGUrsic ML: The role of affective and cognitive decision-making processes during questionnaire completion. Psychol Mark 11:4935101994

    • Search Google Scholar
    • Export Citation
  • 10

    McCarthy MJHGrevitt MPSilcocks PHobbs G: The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J 16:211121172007

    • Search Google Scholar
    • Export Citation
  • 11

    Papuga MOMesfin AMolinari RRubery PT: Correlation of PROMIS Physical Function and Pain CAT instruments with Oswestry Disability Index and Neck Disability Index in spine patients. Spine (Phila Pa 1976) 41:115311592016

    • Search Google Scholar
    • Export Citation
  • 12

    Pool JJMOstelo RWJGHoving JLBouter LMde Vet HCW: Minimal clinically important change of the Neck Disability Index and the Numerical Rating Scale for patients with neck pain. Spine (Phila Pa 1976) 32:304730512007

    • Search Google Scholar
    • Export Citation
  • 13

    Rabin Rde Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:3373432001

  • 14

    Roland MFairbank J: The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976) 25:311531242000

    • Search Google Scholar
    • Export Citation
  • 15

    Spiegel MALafage RLafage VRyan DMarascalchi BTrimba Y: Developing the Total Disability Index based on an analysis of the interrelationships and limitations of Oswestry and Neck Disability Index. Spine (Phila Pa 1976) 41:74812016

    • Search Google Scholar
    • Export Citation
  • 16

    Strine TWHootman JM: US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum 57:6566652007

  • 17

    Turk DCMarcus DA: Assessment of chronic pain patients. Semin Neurol 14:2062121994

  • 18

    Vernon H: The Neck Disability Index: state-of-the-art, 1991-2008. J Manipulative Physiol Ther 31:4915022008

  • 19

    Vernon HMior S: The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 14:4094151991

  • 20

    Wang MBatt KKessler CNeff AIyer NNCooper DL: Internal consistency and item-total correlation of patient-reported outcome instruments and Hemophilia Joint Health Score v2.1 in US adult people with hemophilia: results from the Pain, Functional Impairment, and Quality of life (P-FiQ) study. Patient Prefer Adherence 11:183118392017

    • Search Google Scholar
    • Export Citation
  • 21

    Yeung SSGenaidy ADeddens JAlhemood ALeung PC: Prevalence of musculoskeletal symptoms in single and multiple body regions and effects of perceived risk of injury among manual handling workers. Spine (Phila Pa 1976) 27:216621722002

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 409 409 71
Full Text Views 48 48 15
PDF Downloads 26 26 5
EPUB Downloads 0 0 0
PubMed
Google Scholar