***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the sensitivity to change of three algofunctional scales for neck pain . METHODS Observational , prospect i ve study . Patients with neck disorders were included .  Pain and patients ' perceived h and icap assessed on visual analogue scales ( VAS Pain , VAS H and icap ) , and functional disability measures ( Neck Disability Index , Neck Pain and Disability Scale , Northwick Park Neck Pain Question naire  )  were recorded twice , at baseline and at an 11-month follow-up assessment . Sensitivity to change was assessed using the effect size ( ES ) and the st and ardised response mean ( SRM ) , and the non-parametric Spearman 's rank correlation coefficient ( r ) was used to assess the correlation between quantitative variable changes and patients ' overall opinion . Analysis of variance ( ANOVA ) followed by a Tukey-test was performed to determine if the scales distinguished improved , stable , and deteriorated patients . RESULTS Seventy-one patients ( 43 women , mean age 49 years ) were included and evaluated twice at an interval of 11 + /- 2 months . The three scales showed good sensitivity to change . The ANOVA showed a group effect , and individual changes in the scales scores were statistically different in two-by-two comparisons ( improved , stable or deteriorated patients ) . Changes in NPDS scores had the highest correlation with patient 's overall assessment ( r = 0.592 ) . CONCLUSION The three scales can detect changes in patients with neck disorders . Changes in NPDS score had the best correlation with patients ' overall opinion concerning their neck disorder and this question naire should be given preference in clinical trials STUDY DESIGN Prospect i ve , single-group observational design . OBJECTIVES To determine the minimal clinical ly important difference ( MCID ) for the Disabilities of the Arm , Shoulder and H and ( DASH ) outcome measure and its shortened version ( QuickDASH ) in patients with upper-limb musculoskeletal disorders , using a triangulation of distribution- and anchor-based approaches . BACKGROUND Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process . METHODS The DASH and QuickDASH were administered to 255 patients ( mean ± SD age , 49 ± 15 years ; 156 women ) before and after a physical therapy program .  The external anchor administered after the program was a 7-point global rating of change scale . RESULTS The test-retest reliability of the DASH and QuickDASH was high ( intraclass correlation coefficient model 2,1 = 0.93 and 0.91 , respectively ; n = 30 ) . The minimum detectable change at the 90 % confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH . After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis , the following MCID values were selected : 10.83 points for the DASH ( sensitivity , 82 % ; specificity , 74 % ) and 15.91 points for the QuickDASH ( sensitivity , 79 % ; specificity , 75 % ) . After treatment , the MCID threshold was reached/surpassed by 61 % of subjects using the DASH and 57 % using the QuickDASH . CONCLUSION The MCID values from this study for the DASH ( 10.83 points ) and the QuickDASH ( 15.91 points ) could represent the lower boundary for a range of MCID values ( reasonably useful for different population s and context ual characteristics ) . The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website OBJECTIVE This study compares the sensitivity to change of the Neck Disability Index ( NDI ) and the Neck Bournemouth Question naire ( NBQ ) in patients with chronic uncomplicated neck pain . METHODS This prospect i ve longitudinal study was completed in an outpatient physical therapy clinic . Subjects , with uncomplicated neck pain ( no concurrent shoulder pain or nerve root symptoms ) for more than a 3-month duration , participated in a 4-week course of therapy that included moist heat , neck exercises , and either mobilization or massage . Outcome measures included st and ardized response means ( sensitivity to change ) , Cronbach alpha ( internal consistency ) , and 2-way Spearman correlations between the 2 question naires and between a pain Visual Analog Scale and each question naire ( convergent validity ) . RESULTS Mean ( SD ) score change of the NDI was 6.22 ( 5.12 ) , and of the NBQ , 14.00 ( 11.99 ) . St and ardized response means were 1.21 and 1.17 , respectively . Both question naires were more sensitive to change than the pain Visual Analog Scale ( 0.68 ) . There was moderate correlation between the change scores of all 3 outcome tools ( Spearman 0.46 - 0.57 ) . The NBQ had higher internal consistency than the NDI . CONCLUSIONS The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain . Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain . Both had acceptable internal consistency and are appropriate for use as single- outcome scales Self question naires are an important aspect of the management of neck pain patients . The Bournemouth Question naire ( BQ ) , based on the biopsychosocial model , is design ed to evaluate patients with neck pain . The vali date d English version of this question naire ( BQc-English ) has psychometric properties that range from moderate to excellent . The goal of this study is to translate and vali date a French version of the Bournemouth Question naire for neck pain patients ( BQc-f ) . Its translation and adaptation are performed using the translation back-translation method , generating a consensus among the translators . This validation study was performed on 68 subjects ( mean age 41 years old ) who participated in a r and omized controlled trial regarding the efficiency of manual therapy for neck pain patients . This experimental protocol was design ed to generate data in order to evaluate the construct validity , longitudinal validity , test-retest reliability and responsiveness . The BQc-f psychometric properties of construct validity ( r = 0.67 , 0.61 , 0.42 ) for pre treatment , post treatment and longitudinal validity , respectively ) , test-retest reliability ( r = 0.97 ) and responsiveness ( effect size = 0.56 and mean st and ardized response = 0.61 ) are sufficient to suggest it could be used in the management of patients with neck pain Study Design . Observational prospect i ve study . Objective . Vali date the Spanish version of the Neck Disability Index ( NDI ) . Summary of Background Data . The NDI is the most widely used neck pain scale in the largest number of population s and has been vali date d most often against multiple measurements of function , pain , and clinical signs and symptoms . Methods . The Spanish version of the NDI was administered 2 or 3 times to 175 individuals with neck pain ( including those requesting or not requesting specific healthcare at a given time and those with acute and subacute/chronic nonspecific or post-traumatic neck pain ) . After establishing the factorial structure by extracting the main components , the internal consistency was assessed with the Cronbach alpha method , the test-retest reliability was assessed with the Bl and -Altman plot and the intraclass correlation coefficient methods , and the validity was established by calculating Pearson correlation coefficient with pain visual analogue scale values and with Northwick Park Neck Pain Question naire ( Spanish version ) values . Sensitivity to change was estimated while comparing the mean difference between the first application of the NDI score and the one after the treatment in the patients who improved , felt the same , or worsened . Results . A single factor explained 51.6 % of the variance , the Cronbach alpha score was 0.89 , the intraclass correlation coefficient was 0.98 , the Pearson correlation coefficient with pain visual analogue scale was r = 0.65 and with Northwick Park Neck Pain Question naire was r = 0.89 . In the subgroup of 147 subjects in whom the sensitivity to change was studied , those who reported an improvement in neck pain showed a decrease in the NDI score of 8.20 , those who felt the same showed a decrease of 0.23 , and those who felt worse showed an increase of 5.55 . Conclusion . This first Spanish version of the Neck Disability Index is reliable , valid , and sensitive to change Study Design . A prospect i ve cohort study with a 7‐week follow‐up of 113 patients with chronic neck pain undergoing physiotherapy . Objective . To examine the responsiveness of the Portuguese Version of the Neck Disability Index ( NDI‐PT ) , and to determine the minimal clinical ly important difference ( MCID ) , minimal detectable change ( MDC ) , and floor/ceiling effects . Summary of Background Data . Studies that determine MDC and MCID are needed to provide more accurate outcome evaluation and critically assess potential relevant sources for differences in the minimal important change values for the NDI . Methods . The NDI‐PT was administered twice : at the baseline and after 7 weeks of physiotherapy treatment . A Global Transition Scale was used as an external criterion measure to distinguish between improved and nonimproved patients ’ scores between baseline and follow‐up . The responsiveness of the NDI‐PT was assessed through anchor‐based methods ( correlation coefficient and receiver operating characteristics curves — ROC curves ) . The MCID was estimated by the ROC curve method , and the MDC through the st and ard Error of Measurement ( SEM ) . Results . The NDI‐PT revealed moderate responsiveness when applied to patients with chronic neck pain undergoing physiotherapy ( & rgr ; = 0.328 and area under the curve of 0.595 , 95 % confidence interval : 0.484–0.706 ) . The MDC achieved 12 points , whereas the MCID was found to be 5.5 points . A complementary ROC analysis based on percentage differences in NDI‐PT scores from baseline revealed an optimal cutoff point of 27 % . The optimal cutoff point was found to be dependent of disability baseline scores . Conclusion . The NDI‐PT demonstrated moderate levels of responsiveness . The amount of change in question naire scores perceived by the patient to be meaningful is smaller than the amount of change required to be statistically 95 % confident that score change is not just measurement error . Level of Evidence : PURPOSE Report the test-retest reliability , construct validity , minimum clinical ly important difference ( MCID ) , and minimal detectable change ( MDC ) for the Neck Disability Index ( NDI ) . STUDY DESIGN / SETTING Cohort study of patients presenting to outpatient physical therapy clinics . PATIENT SAMPLE Ninety-one subjects with a primary complaint of neck pain , with or without concomitant upper extremity ( UE ) symptoms , who were participants in a r and omized clinical trial . OUTCOME MEASURES NDI and the 15-point Global Rating of Change ( GRC ) self-report measures . METHODS All subjects completed the NDI at baseline and at a 3-week follow-up . Additionally , subjects completed the GRC scale  , which was used to dichotomize patients into improved or stable groups . Changes in the NDI were used to assess test-retest reliability , construct validity , MCID , and MDC . RESULTS Test-retest reliability was moderate for the NDI ( intraclass correlation coefficient , 0.64 ; 95 % confidence interval , 0.19 - 0.84 ) . For the NDI , the MCID was 7.5 points and the MDC was 10.2 points . CONCLUSIONS The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms . Because the MCID is within the bounds of measurement error , a 10-point change ( the MDC ) should be used as the MCID A prospect i ve cohort study with a 1 week follow-up . To examine the reliability and responsiveness of the Dutch version of the Neck Disability Index ( NDI ) in patients with acute neck pain in general practice . An increasing number of studies on treatment options is published in which the NDI is used . Reports of the ability of the NDI to detect change over time , often called responsiveness , however have not yet been published . At baseline 187 patients ( 119 women , 68 men ) were included . They completed a question naire on demographic variables , self-reported cause of their complaints and the NDI . After 1 week , 86 patients were sent the NDI again together with the perceived recovery scale which was used as our external criterion . The scale ranged from 1 ( complete recovery ) to 7 ( complaints are worse than ever ) . Response rate was 93 % . Test – retest scores on reliability were good ( ICC = 0.90 ) . A Bl and and Altman plot and a graph of total sum score differences showed no visible tendency towards unequal spreading of the data . For patients that reported on the perceived recovery scale that they were “ stable ” we found a responsiveness ratio of 1.82 . The st and ard error of measurement ( SEM ) was 0.60 what result ed in a minimal detectable change ( MDC ) of 1.66 . The NDI has shown to be a reliable and responsive instrument in patients with acute neck pain in general practice Study Design . Prospect i ve , single-cohort study . Objective . To assess the minimal clinical ly important change ( MCIC ) on the Neck Disability Index ( NDI ) and the Numerical Rating Scale ( NRS ) for pain in patients with neck pain . Summary of Background Data . Both measurement instruments are frequently used in research and clinical practice , but which changes are clinical ly relevant is still unknown . Methods . The  MCIC  was estimated with 2 different methods , both integrating an anchor-based and distribution-based approach : the minimal detectable change ( MDC ) and the optimal cutoff point of the ROC curve . The study population consisted of 183 patients with nonspecific neck pain . Results . The results show an MDC of 10.5 points for the NDI ( scale range 
    Output:
    
Conclusions Several patient-reported outcome measures are now available for assessing Italian people with non-specific neck pain .
While the Neck Disability Index is the one most widely used , the Neck Bournemouth Question naire appears the most promising tool from a psychometric point of view