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J Clin Epidemiol. 2016 Nov;79:31-40. doi: 10.1016/j.jclinepi.2016.03.015. Epub 2016 Mar 31.

Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form-36 were evaluated in patients with neck pain.

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Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; CopenRehab, Section of Social Medicine, Department of Public Health, Sund Vækst Huset, University of Copenhagen, Henrik Pontoppidansvej 4, 2200 Copenhagen N, Denmark. Electronic address:
Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Toronto Western Hospital, University of Toronto, MP11-322, 399 Bathurst Street, Toronto, Ontario, Canada.



To assess reliability, construct validity, responsiveness, and interpretability for Neck OutcOme Score (NOOS), Neck Disability Index (NDI), and Short Form-36 (SF-36) in neck pain patients.


Internal consistency was assessed by Cronbach alpha. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC), and measurement error was estimated from the standard error of measurement. Responsiveness was assessed as standardized response mean (SRM) and interpretability from the minimal important difference (MID). Construct validity was tested correlating subscale scores from NOOS and SF-36 and NDI items.


At baseline, 196 neck pain patients were included. Cronbach α was adequate for most NOOS subscales, NDI, and SF-36 with few exceptions. Good to excellent reliability was found for NOOS subscales (ICC 0.88-0.95), for NDI, and for SF-36 with few exceptions. For NOOS, minimal detectable changes varied between 1.1 and 1.9, and construct validity was supported. SRMs were higher for NOOS subscales (0.19-0.42), compared to SF-36 and NDI. MID values varied between 15.0 and 24.1 for NOOS subscales.


In conclusion, the NOOS is a reliable, valid, and responsive measure of self-reported disability in neck pain patients, performing at least as well or better than the commonly used SF-36 and NDI.


Construct validity; Interpretability; Measurement instrument; Neck pain; Patient-reported outcome; Questionnaire; Reliability; Responsiveness

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