Neck Pain and Disability Scale - Literature review Example

?NECK PAIN AND DISABILITY SCALE Introduction The increased prevalence of neck pain and the disabilities associated with this condition leads to dire need for a method for measuring cervical pain. Through medical research, various methodologies have been developed for the measurement of the components of neck pain but the Neck Pain and Disability Scale (NPAD) has been described as the most reliable valid approach of measuring pain and disability within the cervical region. This is attributed to the multidimensional structure of this scale which enables clinicians and researchers to effectively measure the various aspects of neck pain. Through the NPAD, clinicians have been enabled to make accurate medical decisions on the best approach of therapy for a particular component of neck pain. This paper is a literature review of the Neck Pain and Disability Scale which includes an evaluation of its validity and reliability in the measurement of neck pain within a population. The paper also discusses the clinical application of NPAD in addition to the appraisal and recommendations for the use of NPAD in the measurement of neck pain. Neck pain is a medical condition that is commonly reported among adults. According to Blozik, Himmel and Scherer (2011, p. 882), neck pain has contributed to disability and even loss of employment. The measurement of neck pain incidence is diverse among various populations but 35-50 percent of the adult population is generally reported to have been affected neck pain and the disabilities related to this condition as illustrated by Clair, Edmondston and Allison (2004, p. 43). The causation of neck pain has been demonstrated by clinical samples as being attributed to injuries related to work, vehicle accidents and personal injuries. Jorritsma, de Vries and Reneman (2010) assert that motor vehicle accidents contribute to about 40% of the neck injury incidences with only 4% of such injuries being related to one’s occupation and 14% to personal injury. This illustrates that it is only 42% of the adult population that has not reported to conditions related to neck disabilities or pain. Branford, Evans and Nelson (2001, p. 788) assert that it is through involuntary contraction of cervical muscles that neck pain is experienced. However, it is important to note that when muscles are involved in the causation of neck pain the condition is usually referred to as myofascial pain syndrome. Chronic neck pain is described as a neck pain that is experienced for a period of more than three months and may lead to disability. Gatchel, Mayer and Theodore (2006, p. 72)points out that chronic pain of the neck has many aspects which include the sensory experience of the pain, intensity, emotional aspect and the disability which results from the pain. Because of the apparent seriousness of neck pain, measures of measuring it becomes necessary for reasons of research or clinical treatment. To measure the neck pain, some scales have been designed by researchers. Scales such as the Pain Disability Index (PDI) and the Oswestry Disability Scale are considered to be general pain measurement as explained by Jorritsma, Vries and Reneman (2012, p. 93). The need for subjectivity and specificity in the measuring of the pain index which is associated with the cervical spine led to the reliable and valid scales to measure neck pain. Pressure algometry for example was applied in the measurement of neck pain through measuring muscle tenderness around the neck. Because this approach was affected by the threshold of pain that a patient was able to withstand, it was considered less valid for the measurement of neck pain. The Neck Pain and Disability Scale is an ultra modern development that is considered as the most comprehensive neck pain measurement tool and thus valid and reliable as explained by Durand, Loisel and Charpentier (2002, p. 191). Skelly (2008, p. 67) says that the validity of the Neck Pain and Disability Scale is demonstrated by its ability to measure all components of neck pain. In clinical tests for the Neck Pain and Disability Scale, a study population was analyzed on the general neck problems and the pain intensity. Moreover, the study population was measured in relation to how neck pain affected their emotions and cognition. The effect of neck pain on the functionality of the patients was also measured by this method. The results illustrated 76% variance from the 20 items which were loaded with an intension of measuring all the four components of neck pain. Vernon and Mior (1991, p. 409) point out that the success of the clinical tests has made the Neck Pain and Disability Scale to be a preferred and widely used measurement scale for neck pain and its related disabilities. Witt, Jena and Willich (2006, p. 98) explain that neck pain measurement with the Neck Pain and Disability Scale makes patients to respond to each of the test items by drawing a long line which is used to reflect the properties being measured through a visual analogue scale. The reliability and validity of the Neck Pain and Disability Scale, when compared with other neck pain measurement tools, shows that this method is more sensitive in the measurement of all aspects of neck pain than other methods. According to Howell (2011, p. 211), comparative studies illustrate that Neck Pain and Disability Scale is more reliable and valid than the method of measuring the general pain and disability of patients. Additionally, Neck Pain and Disability Scale were found to be more sensitive in the measurement of neck pain than pressure algometry even though both these methods have passed test validity and reliability. The clinical application of the Neck Pain and Disability Scale is in the determination of whether clinical treatment is relevant to the aspect of neck pain that the treatment plan aims at achieving. Bremerich, Grob, Dvorak and Mannion (2008, p. 1018) explain that this is made possible by dividing the total score in the scale with the factor scores which represent the various aspects of neck pain such as the emotional component, functionality and disability. Jorritsma, Vries and Reneman (2012, p. 93) add that the Neck Pain and Disability Scale is suitable in clinical application because it helps clinicians to determine the neck pain aspects which show significant treatment effects. During clinical trials for the Neck Pain and Disability Scale, the intensity of neck pain and disruption of life activities were found to be the neck pain aspects that demonstrated significant therapy effects. The other components of neck pain received only moderate benefits from therapy. According to Lord, Barnsley and Wallis (1996, p. 1721), the Neck Pain and Disability Scale which was developed in the US has been translated into German, French, Italian, English, Dutch and Turkish and they show adequate reliability and validity. Provinciali, Baroni and Illuminati (1996, p. 105) illustrate that French neck pain patient samples were used to test the validity and reliability of the Neck Pain and Disability Scale in relation to other methods such as the Neck Disability Index and showed that NPAD is the best multidimensional approach of measuring all components of neck pain. These studies were done by the use of the French translation of the Neck Pain and Disability Scale on chronic neck pain patients and thus show that the translations are reliable and valid in the measurement of neck pain within the various populations. Bremerich, Grob, Dvorak and Mannion (2008, p. 1018) assert that studies presented in research papers indicate that the French translation of the Neck Pain and Disability Scale shows some difference with the English translation in the number of the components of neck pain. Three major components resulted from French studies of neck pain in the application of the French translation of the neck and disability scale. These three factors demonstrated a 78% variance. The French studies of neck pain are shown to be close to the original analysis through the Neck Pain and Disability Scale and the third component was also related to the impact of neck pain on the emotional aspects of the patient. According to Scherer, Blozik and Herrmann-Lingen (2008, p. 922), the French translation of the Neck Pain and Disability Scale and the French studies on neck pain played an important role in the revalidation of the NPAD especially in relation to its multidimensional structure of measuring all the components of neck pain. As explained by Agarwal, Allison, Agarwal and Singer (2006, p. 1405), research literature concur that Neck Pain and Disability Scale is a reliable and valid method of measuring neck pain both for clinical reasons and research. NPAD questionnaires provide a consistent and responsive tool for measuring the clinical condition of patients with neck pain. The questionnaires are very effective in giving patients a self rated clinical experience that enables them to give accurate information for the use of clinicians with an objective of making their condition better. In general, research literature agrees that NPAD is a reliable measurement tool that is sensitive to all aspects of the patient’s neck pain. Moreover, the Neck Pain and Disability Scale provide ground for research possibilities that aim at improving neck pain measurement. According to Provinciali, Baroni and Illuminati (1996, p. 105), research literature support the use of the Neck Pain and Disability Scale by research literature is attributed to its validity and the fact that it correlates perfectly with other methodologies of measuring neck pain. However research literature suggests that more studies on the NPAD are necessary so that the ability of this tool in the determination of the emotional component of neck pain is enhanced as explained by Wheeler and Goolkasian (1999, p. 1290). Research literature has focused on the multicultural application of the Neck Pain and Disability Scales through the analysis of the various translations of the original scale and the maintained validity and reliability in measuring various components of neck pain. Even though there are minor differences among the translations, the validity of the NPAD has been maintained in various societies. The support of research literature for the NPAD is centered at its compliance to the international standards of pain measurement determination of the extent of disability in patients which results from pain. The German version of NPAD has specifically received support from research literature that is based on studies done in Germany to determine the sensitivity of NPAD to the components to neck pain. Jorritsma, Vries and Reneman (2012, p. 93) point out that in German, patients with chronic neck pain who undergo clinical studies demonstrate that the NPAD is valid and reliable in determining the extent to which neck pain is affecting the functionality of patients within their life processes which acts as a basis for the application of relevant therapy for the victims. Bremerich, Grob, Dvorak and Mannion (2008, p. 1018) recommend that in the measurement of neck pain and the related disabilities for clinical purposes or research, the Neck Pain and Disability Scale is the most valid and reliable method because of its sensibility to various aspects of neck pain. The multifunctional structure of the NPAD tools enables the determination of how neck pain affects the life activities in addition to its contribution to disability among patients. Wheeler and Goolkasian (1999, p. 1290) assert that the translations of the NPAD should be analyzed through research to determine if they are as valid and reliable as the original NPAD to allow clinicians apply them in the management of neck pain among patients. Determination of the various components of neck pain is important to the diagnosis of the exact condition of the patient and helps clinicians to determine the best root of therapy for their patients. The Neck Pain and Disability Scale is therefore recommended for clinical evaluation within various populations as the most effective approach of obtaining reliable and valid information to clinical decision making. The Neck Pain and Disability Scale questionnaire should include all aspects of neck pain within the questions that are presented to the patients. Stratford, Binkley, Riddle (1996, p. 1109) say that clinicians and researchers should validate the questions within these questionnaires to ensure that they contain all components of neck pain. This is important because it would allow them to determine the intensity of the pain and thus lead to accurate categorization of the pain. As a result, relevant therapeutic measures will be provided by the medical care which would lead to the betterment of the health and thus life of the patient. On the other hand Persson (2006, p. 122) says that because the Neck Pain and Disability Scale does not sufficiently measure the extent to which neck pain affects the emotional functioning of the patient, more research on neck pain is recommended. It is through such research that the establishment of emotional implication of neck pain and how it affects the psychological well being of the patient. Research would be the most appropriate avenue of recommending the appropriate psychological approach in the treatment of neck pain as demonstrated by Goolkasian (2003, p. 379). Conclusion The Neck Pain and Disability Scale is the most valid and reliable method of measuring neck pain and the related disabilities because of its multidimensional structure which enables clinicians and researchers to be able to measure the various components of neck pain with effectiveness. NPAD is applicable in clinical management of neck pain as it assists practitioners to make an accurate diagnostic approach in the management of various aspects of neck pain. It is recommended that more research be conducted on NPAD in order to enhance its effectiveness in the measurement of the emotional aspect of neck pain. References Agarwal, S, Allison, G, Agarwal, A, and Singer, K 2006, 'Reliability and validity of the Hindi version of the Neck Pain and Disability Scale in cervical radiculopathy patients', Disability and Rehabilitation, 28, 22, pp. 1405-1412. Bronfort G, Evans R, and Nelson B, A 2001, “Randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain, Spine, 26:788–797 Bremerich, F, Grob, D, Dvorak, J, and Mannion, A 2008, 'The Neck Pain and Disability Scale', Spine, 33, 9, pp. 1018-1027. Blozik, E, Himmel, W, and Scherer, M 2011, 'Sensitivity to change of the Neck Pain and Disability Scale', European Spine Journal, 20, 6, pp. 882-889 Clair, D, Edmondston, S, and Allison, G 2004, 'Variability in pain intensity, physical and psychological function in non-acute, non-traumatic neck pain', Physiotherapy Research International, 9, 1, pp. 43-54. Durand, M., Loisel, P. and Charpentier, N. 2002, "Helping Clinicians in Work Disability Prevention: The Work Disability Diagnosis Interview", Journal of Occupational Rehabilitation, vol. 12, no. 3, pp. 191-204. Goolkasian, P 2003, "Neck Pain and Disability Scale: a critical evaluation", Expert Review of Pharmacoeconomics and Outcomes Research, vol. 3, no. 4, pp. 379-82. Gatchel, R.J., Mayer, T.G. and Theodore, B.R. 2006, "The Pain Disability Questionnaire: Relationship to One-Year Functional and Psychosocial Rehabilitation Outcomes", Journal of Occupational Rehabilitation, vol. 16, no. 1, pp. 72-94. Howell, ER 2011, 'The association between neck pain, the Neck Disability Index and cervical ranges of motion: a narrative review', Journal of the Canadian Chiropractic Association, 55, 3, pp. 211. Jorritsma, W, Vries, G, and Reneman, M 2012, 'Neck Pain and Disability Scale and Neck Disability Index: validity of Dutch language versions', European Spine Journal, 21, 1, pp. 93-100. Jorritsma, W, de Vries, G, and Reneman, M 2010, 'Neck Pain and Disability Scale and the Neck Disability Index: reproducibility of the Dutch Language Versions', European Spine Journal, 19, 10, pp. 1695-1701. Lord S. M, Barnsley L. and Wallis BJ, 1996, “Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain, N Engl J Med, 335:1721–1726 Persson L., 2006, “Neck pain and pillows: a blinded study of the effect of pillows on non-specific neck pain, headache and sleep”, Adv Physiother, 8:122–127. Provinciali L., Baroni M. and Illuminati L, 1996, “Multimodal treatment to prevent the late whiplash syndrome”, Scand J Rehabil Med, 28:105–111. Scherer, M, Blozik, E, and Herrmann-Lingen, C 2008, 'Psychometric properties of a German version of the Neck Pain and Disability Scale', European Spine Journal, 17, 7, pp. 922-929 Skelly, A. 2008, "Neck pain task force collars best treatments", Medical Post, vol. 44, no. 3, pp. 1-76. Stratford P. W, Binkley F. M, Riddle D. L., 1996, “Health status measures: strategies and analytic methods for assessing change scores”, PhysTher, 76(10):1109–1123 Vernon H, Mior S., 1991, “The neck disability index: a study of reliability and validity”, J Manipulative Physiol Ther, pp. 409–415.  Witt, C, Jena, S, and Willich, S 2006, 'Acupuncture for patients with chronic neck pain', Pain (03043959), 125, 1/2, pp. 98-106, Wheeler A. H., Goolkasian P., 1999, “Development of the Neck Pain and Disability Scale”, Spine, 24(13):1290–1294. Read More