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Clinical Notes & Documentation
NECK PAIN DISABILITY INDEX REPORT
Patient: Susan Martin (ID# 563971821)
Date: February 6, 2004
Examined by: David L. Johnson, D.C.
This self-administered subjective test quantifies the degree of functional impairment of individuals with neck pain. Susan scored a 46%, or moderate disability in the ability to perform the normal activities of daily living.
SECTION 1 - PAIN INTENSITY
D) The pain is fairly severe at the moment.
SECTION 2 - PERSONAL CARE (WASHING, DRESSING, ETC)
B) I can look after myself normally, but it causes extra pain.
SECTION 3 - LIFTING
D) Pain prevents me from lifting heavy weights off the floor, but I can manage light to medium weights if they are conveniently positioned.
SECTION 4 - READING
D) I cannot read as much as I want because of moderate pain in my neck.
SECTION 5 - HEADACHES
E) I have severe headaches which come frequently.
SECTION 6 - CONCENTRATION
C) I have a fair degree of difficulty in concentrating when I want to.
SECTION 7 - WORK
C) I can do most of my usual work, but no more.
SECTION 8 - DRIVING
B) I can drive my car as long as I want with slight pain in my neck.
SECTION 9 - SLEEPING
C) My sleep is mildly disturbed (1-2 hours sleepless).
SECTION 10 - RECREATION
C) I am able to engage in most, but not all of my usual recreation activities because of pain in my neck.
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