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.
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
Section 2 — Personal Care
Section 3 — Lifting
Section 4 — Reading
Section 5 — Headaches
Section 6 — Concentration
Section 7 — Work
Section 8 — Driving
Section 9 — Sleeping
Section 10 — Recreation
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.)
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