Open Access Open Badges Research article

Validation of the German version of the Neck Disability Index (NDI)

Holger Cramer1*, Romy Lauche1, Jost Langhorst1, Gustav J Dobos1 and Andreas Michalsen23

Author Affiliations

1 Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany

2 Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Königstraße 63, 14109 Berlin, Germany

3 Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Königstraße 63, 14109 Berlin, Germany

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BMC Musculoskeletal Disorders 2014, 15:91  doi:10.1186/1471-2474-15-91

Published: 19 March 2014



The Neck Disability Index (NDI) is the most commonly used outcome measure for neck pain. This study aimed to determine the psychometric properties of a German version of the NDI. Cross-cultural translation and psychometric testing of the NDI were performed.


The 10-item NDI was translated into German and administered to 558 patients with chronic unspecific neck pain (Mean age 49.9 ± 11.4 years, 76% female). The factor structure and reliability of the NDI were assessed using factor analysis, Cronbach’s alpha, split-half reliability (Spearman-Brown coefficient), and intra-class correlation (ICC2,1). To determine convergent validity, pain intensity (visual analog scale; VAS), pain on movement (VAS), and quality of life (Short Form 36 Health Survey Questionnaire; SF-36) were correlated with the NDI. Correlation with range of motion and sensitivity to change were also assessed in a subsample of 49 patients.


The mean NDI score was 32.75 ± 13.09. Factor analysis revealed a single factor that explained 39.8% of the variance. Cronbach’s alpha was 0.81; Spearman-Brown coefficient was 0.80; and intra-class correlation was 0.81 (95% confidence interval = 0.78, 0.83). Significant correlations were found for pain intensity (r = 0.22, p < 0.01), pain on movement (r = 0.39, p < 0.01), quality of life (r = -0.30 to -0.45, p < 0.01), and range of motion (r = -0.34, p = 0.02). Patients who reported global improvement of health after an exercise or yoga intervention showed a higher decrease on the NDI than patients who reported no global improvement (p < 0.01).


The German version of the NDI has a comparable factor structure as the original version, acceptable psychometric properties, and is sensitive to change after physical activity. Neck disability is associated with other measures of neck pain.

Neck pain; Chronic pain; Disability; Neck disability index; Translation; German; Validity; Reliability; Factor structure; Sensitivity to change